Tarsal tunnel syndrome is an uncommon clinical entity. This article will review the published reports on tarsal tunnel syndrome with respect to its anatomy, cause, pathophysiology, clinical presentation, diagnosis, treatment, and results of treatment in an attempt to improve understanding of this problem.

Tarsal tunnel syndrome: a review of the literature

Tarsal tunnel syndrome is defined as entrapment of the posterior tibial nerve at the level of the ankle. The syndrome has been associated with traumatic inflammatory etiologies. The diagnosis is made clinically by the presence of dysesthesia in the distribution of the medial and lateral plantar nerves, a positive Tinel's sign, paresthesias with compression of the nerve at the tarsal tunnel, tenderness of the nerve along its course (Valleix Phenomenon), and sensory or motor changes. Most authors suggest surgical decompression for the treatment of tarsal tunnel syndrome. The purpose of this review is to summarize the etiologies of tarsal tunnel found in the literature, to evaluate the current role of electrodiagnosis in the diagnosis of tarsal tunnel syndrome and to examine the results of treatment modalities presented.

http://journals.sagepub.com/doi/pdf/10.1177/107110079001100110

Tarsal tunnel syndrome: review of the literature.

Rheumatoid arthritis is a systemic disease that often affects the foot and ankle. Approximately 20% of patients with rheumatoid arthritis present initially with foot and ankle symptoms, and most patients will eventually develop foot and ankle symptoms. Although early intervention includes conservative measures, operative treatment often is needed to adequately treat rheumatoid patients. Treatment of foot and ankle problems in patients with rheumatoid arthritis is directed to maintaining ambulatory capacity. This article reviews the clinical presentation, evaluation, and treatment of rheumatoid arthritis affecting the foot and ankle.

A review of rheumatoid arthritis affecting the foot and ankle.

The connective tissue diseases, such as rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus, systemic sclerosis, and vasculitis, may cause various disorders of the peripheral nervous system. In this review, the clinical effects of the connective tissues diseases on nerve and muscle are examined with particular attention to mononeuritis multiplex, distal symmetric neuropathy, fulminant motor neuropathy, compression neuropathy, sensory neuronopathy, and trigeminal sensory neuropathy.

Neuromuscular complications of connective tissue diseases.

Patients with tarsal tunnel syndrome of unknown etiology do poorly after surgical decompression. Although surgical decompression addresses the soft tissue constraints, it ignores the role of osseous support. Some authors have suggested that a pes planus deformity (i.e., valgus hindfoot and abducted forefoot) is an unrecognized cause of tarsal tunnel syndrome due to increased tibial nerve tension. An in vitro study was performed on nine cadaveric feet to determine the effects of foot position and load on tibial nerve tension. Tensile forces placed through the tibial nerve were measured when the foot was placed in dorsiflexion, eversion, combined dorsiflexion-eversion, and then under cyclical load and increasing internal rotation at 5 degrees increments from 0 degrees to 20 degrees. The nerve tension was reassessed after the creation of a pes planus deformity under the previous conditions. Tibial nerve tension in the stable and unstable foot was significantly increased by eversion, dorsiflexion, and combined dorsiflexion-eversion. Tibial nerve tension was significantly greater in an unstable foot when compared with a stable foot during eversion, dorsiflexion, and combined dorsiflexion-eversion. In the stable foot, tibial nerve tension was significantly increased during axial loading with increasing internal rotation when compared with 0 degrees rotation. The increased tibial nerve tension in the stable foot was significant with increasing internal rotation when 0 degrees was compared with 10 degrees, 15 degrees, and 20 degrees. In the unstable foot, the tibial nerve tension was significantly increased with increasing internal rotation compared with the nerve tension at 0 degrees of rotation. The increased tibial nerve tension in the unstable foot was significant with increasing internal rotation when 0 degrees was compared with 5 degrees, 10 degrees, 15 degrees, and 20 degrees. When stability of the foot and internal rotation were compared independently, each factor increased tibial nerve tension. However, these factors acting together did not significantly compound the increase in nerve tension. This study demonstrates that tibial nerve tension is increased in an unstable foot compared with a stable foot during eversion, dorsiflexion, combined dorsiflexion-eversion, and cyclical load with increasing internal rotation.

The Effects of Foot Position and Load on Tibial Nerve Tension

Forty-eight patients with definite of classical rheumatoid arthritis (RA) were studied for the presence of tarsal tunnel syndrome (TTS). Nerve conduction velocities and distal latencies were determined in a constant temperature room and the findings compared with a group of 35 normal, age-matched subjects. After excluding four patients with peripheral neuropathy, a definite delay in the distal motor latency of the tibial nerve was documented in 11 subjects (25%). Two of the 11 had foot symptoms suggestive of TTS. These 11 patients with prolonged distal motor latencies did not otherwise differ from RA patients without TTS in terms of disease duration or severity, treatment, or the presence of foot deformity. Thus, compressive neuropathy of the branches of the posterior tibial nerve is a relatively frequent finding in patients with definite or classical RA.

R. H. Persellin

Papers

Prevalence of the tarsal tunnel syndrome in rheumatoid arthritis