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What is being compressed by what in tarsal tunnel syndrome?

tibial nerve under the flexor retinaculum
*specifically it is the 1st branch of the lateral plantar n. (distal tarsal tunnel)


what are some common etiologies of tarsal tunnel syndrome?

trauma- laceration, fractures/dislocation, blunt trauma
varicosities or other space-occupying lesions
heel varus
heel valgus
heel spur - causes distal tarsal tunnel compression


What is the physical exam finding called for if teh paresthesias radiate proximally up the leg?

Valleix phenomenon


What physical exam test can be used to clinically diagnose tarsal tunnel syndrome by putting my pressure on the nerve?

dorsiflexion-eversion test- maximally dorsiflexion the digits at the MPJ and evert the ankle to apply tension and compression to the tibial nerve.
will produce better Tinel's sign also.


what are some other DDx for neurolgoic conditions?

L5 or S1 radiculopathy (herniated disc)
sensory polyneuropathy


what PE test could you do to rule in radiculopathy?

straight leg raise test (also called Lasegue's sign)- patient is supine and examiner raises patient's leg with knee straight.
positive sign for sciatica would be pain with cervical spine flexed, stretching the nerve roots


what is teh flexor retinaculum aka?

laciniate ligament


conservative treatment options for tarsal tunnel syndrome?

NSAIDs and corticosteroid injections to control inflammatio
short leg cast or AFO
compression stockings for venous edema


what muscle forms the roof of the porta pedis?



what are the 3 components to surgical decompression of the tarsal tunnel?

1. release of the flexor retinaculum overlying the tarsal tunnel W/O deep suture closure
2. release the abductor fascia in teh porta pedis
3. release tibial nerve and associated plantar branches from surrounding entrapment


for the distal tarsal tunnel syndrome, what nerve is involved?

1st branch of lateral plantar n.
-has motor innervation to ABDM, FDB, QP
-sensory innnervation to calcaneal periosteum, long plantar ligament


clinically, how would you determine the entrapment of the 1st branch of the lateral plantar nerve?

compression over the medial aspect of the heel is more painful than plantar compression.
(why? this palpation pinches the nerve between the deep fascia of the ABH and medial margin of QP)


Where does the impingement occur in distal tarsal tunnel syndrome?

where the nerve passes between the taut deep fascia of the ABH and medial margin of the medial head of QP


what are the insertion sites for flexor retianculum?

medial malleolus to posterior inferior aspect of the calcaneal tuberosity


conservative treatment approaches for tarsal tunnel syndrome?

corticosteroid injections
compressive stockings- if venous insufficiency
short leg cast or AFO


what is a surgical option for treatment for recurrent tarsal tunnel?

use of autogenous saphenous vein graft wrapping (enclosing the tibial n.) as a barrier technique