Tibial Neuropathy Tarsal Tunnel Syndrome

The tarsal tunnel is located at the inferoposterior margin of the medial malleolus. Its boundaries include the bones of the ankle and fibrous flexor retinaculum. The posterior tibial nerve and three flexor tendons of the foot and vessels lie within this tunnel. Compression can occur within the tunnel from tenosy-novitis, enlarged veins, and fracture or dislocation of the ankle. Prolonged standing or walking may lead to vascular stasis and engorgement within the tunnel. A horse jockey is in one of the few occupations associated with this syndrome. The primary symptom of tarsal tunnel syndrome is painful, burning par-esthesias in the sole of the foot that are worse after a day of activity and may extend into the night. The symptoms can be reproduced or exacerbated by gentle percussion over the tarsal tunnel (Tinel's sign). The patient may also have weakness in the intrinsic muscles of the foot, making it difficult to push off during walking. Definitive treatment is surgical decompression involving release of the retinaculum.

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