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Foot (Edinb) 2021 Apr 8;47:101797. Epub 2021 Apr 8.

Northwestern Memorial Hospital, Chicago, IL, USA.

Displaced isolated fractures of sustentaculum tali are rare. Inadequate treatment of these injuries can rarely lead to non-union or mal-union and in most cases are treated non-surgically. We report a unique case of undiagnosed mal-union of sustentaculum tali in the setting of underlying tarsal coalition that resulted in symptoms of tarsal tunnel. Read More

Foot (Edinb) 2021 Apr 8;47:101800. Epub 2021 Apr 8.

School of Electrical and Computer Engineering, University of Campinas, Campinas, SP, Brazil. Electronic address:

Background: Valgus hindfoot is a very common postural deviation, and the associated foot pronation can be a triggering factor for diseases such as tarsal tunnel syndrome.

Research Question: This work compares two techniques for hindfoot valgus correction: GPR (Global Postural Reeducation) and PIMT (Postural Integration by Manual Therapy).

Methods: Sixty young adult subjects from the Brazilian Army with unilateral hindfoot valgus were selected and divided into two groups of 30 subjects, one treated with GPR and the other treated with PIMT. Read More

Rev Esp Cir Ortop Traumatol 2021 May 1. Epub 2021 May 1.

Equipo Tobillo y Pie, Clínica Santa María, Santiago, Chile.

Background: Retrospective review of patients with a diagnosis of Tarsal Tunnel Syndrome (TTS) treated surgically.

Methods: Retrospective series of patients with diagnosis of TTS operated between 2005 and 2020 in the same center. Variables such as age, sex, side, affected nerve or branch, classification, type of imaging study, biopsy result, infection rate, recurrence rate, sequelae, among others, were analyzed. Read More

Clin Podiatr Med Surg 2021 Apr;38(2):131-141

Department of Orthopedics, Catholic Health Initiatives (CHI Health), 16909 Lakeside Hills Court, Suite 208, Omaha, NE 68130, USA. Electronic address:

Tarsal tunnel syndrome is paresthesia and pain in the foot and ankle caused by entrapment and compression of the tibial nerve within the fibro-osseous tarsal tunnel beneath the flexor retinaculum. The most helpful diagnostic criteria are a positive Tinel sign at the ankle and objective sensory loss along the distribution of the tibial nerve. Treatment is designed to reduce the compression of the nerve, and surgical nerve release is indicated with failure of conservative options. Read More

Cureus 2021 Mar 6;13(3):e13729. Epub 2021 Mar 6.

Anatomy, Regional Institute of Medical Sciences, Imphal, IND.

Introduction Tibial nerve is a larger component of the sciatic nerve. It arises from ventral branches (Anterior Division) - L4, L5, S1-S3. Then it travels along the distal border of the popliteus muscle, deep to gastrocnemius and soleus. Read More

J Am Podiatr Med Assoc 2021 Feb;111(1)

Tarsal tunnel syndrome (TTS), resulting from compression of the posterior tibial nerve (PTN) within the tarsal tunnel, is a relatively uncommon entrapment neuropathy. Many cases of tarsal tunnel syndrome are idiopathic; however, some causes, including space-occupying lesions, may lead to occurrence of TTS symptoms. Schwannoma, the most common tumor of the sheath of peripheral nerves, is among these space-occupying lesions, and may cause TTS when it arises within the tarsal tunnel, and it may mimic TTS even when it is located outside the tarsal tunnel and cause a significant delay in diagnosis. Read More

Contemp Clin Trials Commun 2021 Mar 21;21:100725. Epub 2021 Jan 21.

Registrar, Australasian College of Podiatric Surgeons, 3000, Melbourne, Australia.

Introduction: Distal tarsal tunnel syndrome (DTTS) is characterised by compression of the tibial nerve as it passes underneath the abductor hallucis muscle belly. There is no current consensus on treatment for DTTS. This study was conducted to compare and evaluate the effect of ultrasound-guided botulinum toxin A (BTX-A) versus ultrasound-guided corticosteroid injection (CSI) for the treatment of DTTS. Read More

BMJ Case Rep 2020 Dec 22;13(12). Epub 2020 Dec 22.

Orthopaedics, University College of Medical Sciences, Delhi, India

Osteochondroma of the talus is a rare entity that can cause pain, swelling, restriction of movements, synovitis and tarsal tunnel syndrome (TTS). We present three such cases with varying presentation. Case 1 presented with synovitis of the ankle along with a bifocal origin of the talar osteochondroma. Read More

Eur J Radiol 2021 Feb 17;135:109482. Epub 2020 Dec 17.

Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India.

Purpose: This review discusses the relevant anatomy, etiopathogenesis, current notions in clinical and imaging features as well as management outline of lower limb entrapment neuropathies.

Methods: The review is based on critical analysis of the current literature as well as our experience in dealing with entrapment neuropathies of the lower limb.

Results: The complex anatomical network of nerves supplying the lower extremities are prone to entrapment by a heterogenous group of etiologies. Read More

J Orthop Surg (Hong Kong) 2020 Sep-Dec;28(3):2309499020971868

Department of Orthopedics and Traumatology, Faculty of Medicine, Kastamonu University, Kastamonu, Turkey.

Aim: This study compared the results of tarsal tunnel syndrome release surgeries using mini-open incisions and standard incisions.

Patients And Methods: From January 2012 until April 2018, 31 feet of 29 patients diagnosed with tarsal tunnel syndrome were treated surgically. 15 feet of 15 patients underwent surgeries utilizing minimally open technique and 16 feet of 14 patients underwent surgeries utilizing standard incisions. Read More

Int J Surg Case Rep 2020 21;76:510-516. Epub 2020 Oct 21.

Department of Orthopedics, Institute of Biomedical Science, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima, 770-8503, Japan. Electronic address:

Introduction: There are some reports of tarsal tunnel syndrome (TTS) entrapment/impingement from bony factors, including exostosis and fragment, but there are no reports on TTS with traumatic osteoarthritis of the ankle that were treated with osteophyte excision for TTS and arthroscopic arthrodesis for osteoarthritis of the ankle.

Presentation Of Case: A 61-year-old woman with left trimalleolar fracture had undergone surgery 3 years earlier and was referred to our hospital for further investigation of persistent left ankle pain and numbness around the left medial malleolus and plantar aspect of the foot. Clinical examination demonstrated plantar hypesthesia and a positive Tinel's sign at the tarsal tunnel. Read More

J Clin Neurophysiol 2020 Jul;37(4):299-305

Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; and.

Entrapment neuropathies cover a wide range of isolated nerve injuries along the course of the upper and lower extremity nerves. Electrodiagnostic (EDX) testing is usually an essential part of the evaluation of entrapment neuropathies, and examinations for the most common entrapment neuropathies, carpal tunnel syndrome and ulnar neuropathy at the elbow, constitute a significant part of the daily work in EDX laboratories. Despite this, guidelines for EDX testing are generally sparse or do not exist for entrapment neuropathies, whereas a wide variety of different techniques are available to the clinical neurophysiologist. Read More

Cell Tissue Bank 2021 Mar 27;22(1):115-122. Epub 2020 Oct 27.

Department of Hand and Foot Surgery, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, 130021, Jilin, China.

Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve or its terminal branches compressed by its fibro-osseous tunnel beneath the flexor retinaculum on the medial side of the ankle. The current study was a retrospective study of 107 cases of patients with TTS, in which the onset characteristics were summarized, the factors that might affect the surgical treatment effects of TTS were discussed and analyzed. The syndrome diagnoses and treatment experiences of TTS were extracted and analyzed. Read More

Case Rep Orthop 2020 14;2020:8851920. Epub 2020 Sep 14.

Department of Orthopaedic Surgery, University Hospital Centre Zagreb, Šalata 6-7, 10 000 Zagreb, Croatia.

Accessory soleus muscle (ASM) is a rare supernumerary anatomical variant that commonly presents as a posteromedial ankle swelling, which may become painful during physical activity. As it may mimic a soft tissue tumor, it is essential to differentiate this condition from ganglion, lipoma, hemangioma, synovioma, and sarcoma. However, ASM may also present with a painful syndrome, characterized by pain and paresthesia of the ankle and foot, mimicking the tarsal tunnel syndrome (TTS). Read More

Medicine (Baltimore) 2020 Sep;99(39):e22369

Department of Acupuncture-Moxibustion, China-Japan Friendship hospital, Beijing.

Background: Tarsal tunnel syndrome (TTS) is a painful condition of the ankle that affects patients' quality of life and ability to work. Multiple clinical studies of nerve decompression by acupotomy have been published in China, and the results are encouraging. However, the efficacy and security of this treatment have not been evaluated scientifically and systematically. Read More

J Ultrasound Med 2021 Apr 3;40(4):821-838. Epub 2020 Sep 3.

Private Ultrasound Center Graz, Lassnitzhoehe, Austria.

Ultrasound is considered an excellent imaging modality to evaluate the nerves of the limbs. The deep peroneal nerve (DPN) is one of the terminal branches of the common peroneal nerve. The DPN may be affected by various disorders, which may be clinically challenging to show. Read More

Pain Med 2020 08;21(Suppl 1):S64-S67

Division of Pain Medicine, Department Anesthesiology and Pain Medicine, University of California, Davis, California, USA.

Objective: Peripheral nerve stimulation (PNS) of the lower extremity has progressed significantly over the last decade. From the proof of concept that ultrasound-guided, percutaneous implantation was possible to advances in waveforms, the field has been rapidly evolving. While most nerves in the lower extremity can be PNS targets, consideration must be given to the ergonomics of pulse generator placement, patient comfort, and avoidance of lead migration. Read More

Ann Palliat Med 2020 Sep 6;9(5):3546-3552. Epub 2020 Aug 6.

Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea.

Rearfoot disorders are frequently encountered in clinical practice. We reviewed common rearfoot disorders and present conservative treatments, focusing on shoe modification and the application of insoles or orthoses. Achilles tendinopathy is caused by excessive mechanical loads on the gastrocnemius and soleus muscles. Read More

Medicine (Baltimore) 2020 Jul;99(31):e21474

Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea.

Rationale: Tibial nerve injury is a sustainable but rare complication during total-ankle arthroplasty (TAA). We outlined 2 previously unreported cases of tibial nerve injury in TAA, including the prognoses and possible causes.

Patient Concerns: First, a 63-year-old woman complained of a 5-month history of persistent tingling sensation and numbness on the medial and plantar aspects of her foot after TAA. Read More

Best Pract Res Clin Rheumatol 2020 06 31;34(3):101565. Epub 2020 Jul 31.

Department of Neurology, 60 Fenwood Road, 4th Floor, Boston, MA, 02115, USA. Electronic address:

Entrapment neuropathies are frequently encountered by rheumatologists, not only because they are common but also because of their association with certain rheumatological and systemic disorders. Recognizing entrapment neuropathy early can help avoid progressive neurological deficits, as well as facilitate appropriate treatment measures, which can effectively minimize a patient's symptoms. Entrapment neuropathies may be distinguished from other musculoskeletal causes of lower extremity pain by identifying characteristic patterns of weakness and/or sensory loss, so a focused bedside neurological examination is key for diagnosis. Read More

Clin Neurophysiol Pract 2020 2;5:135-138. Epub 2020 Jul 2.

Department of Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical College, Takatsuki, Japan.

Objectives: The sensitivity of nerve conduction studies (NCSs) of the medial and lateral plantar nerves for the diagnosis of tarsal tunnel syndrome (TTS) is not high enough. The near nerve method (NNM) is a recording technique for NCSs that allows the recording of large, clear potentials. The NNM was reported to improve the sensitivity of diagnoses of TTS. Read More

BMC Musculoskelet Disord 2020 Jul 25;21(1):491. Epub 2020 Jul 25.

Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 200-704, Republic of Korea.

Background: Tarsal tunnel syndrome is an entrapment neuropathy that can be provoked by either intrinsic or extrinsic factors that compresses the posterior tibial nerve beneath the flexor retinaculum. Osteochondroma, the most common benign bone tumor, seldom occur in foot or ankle. This is a rare case of tarsal tunnel syndrome secondary to osteochondroma of the sustentaculum tali successfully treated with open surgical excision. Read More

Orthop Traumatol Surg Res 2020 Jul 15:102630. Epub 2020 Jul 15.

Service de Radiologie, Groupement Hospitalier Sud, 165, chemin du Grand-Revoyet, 69310 Pierre Bénite, France; Université de Lyon, Lyon, France.

Introduction: The axial cross-sectional area (CSA) of the tibial nerve can be measured with ultrasonography. In patients who have posteromedial tarsal tunnel syndrome (TTS), there is little information on the nerve's CSA even though this information could be useful for determining whether the nerve is damaged. This led us to carry out a case-control study in which the tibial nerve's axial CSA was measured in healthy patients and in patients with TTS. Read More

Medicine (Baltimore) 2020 Jun;99(26):e20893

Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Dongam-gu, Cheonan.

Rationale: Tarsal tunnel syndrome (TTS) is a compressive neuropathy of the posterior tibial nerve and its branches. Tarsal coalition is defined as a fibrous, cartilaginous, or osseous bridging of 2 or more tarsal bones. TTS with tarsal coalition is uncommon. Read More

World Neurosurg 2020 09 12;141:142-148. Epub 2020 Jun 12.

Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan.

Background: Surgery for idiopathic tarsal tunnel syndrome (TTS) is of limited effectiveness or ineffective. Using indocyanine green video angiography (ICG-VA), we treated idiopathic TTS by posterior tibial artery (PTA) decompression from the posterior tibial nerve (PTN) and evaluated postoperative patency of the PTA.

Methods: We treated 12 patients (12 feet) with idiopathic TTS by PTA decompression from the PTN and transposed its location. Read More

Folia Morphol (Warsz) 2020 Jun 3. Epub 2020 Jun 3.

Department of Anatomy, Jagiellonian University Medical College, 12th Kopernika Street, 31-034 Cracow, Poland.

Background: The purpose of this study was to evaluate the topographic anatomy of the tibial nerve and its medial calcaneal branches in relation to the tip of the medial malleolus and to the posterior superior tip of the calcaneal tuberosity using the ultrasound examination and to verify its preoperative usefulness in surgical treatment.

Materials And Methods: Bilateral ultrasound examination was performed on 30 volunteers and the location of the tibial nerve bifurcation and medial calcaneal branches origin were measured. Medial calcaneal branches were analyzed in reference to the amount and their respective nerves of origin. Read More

Arthrosc Tech 2020 Apr 27;9(4):e559-e563. Epub 2020 Mar 27.

Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong SAR, China.

Posterior ankle pain is a common foot and ankle problem faced by orthopaedic surgeons. It can have many causes, including posterior ankle joint pathologies (synovitis or osteochondral lesion), ankle impingement (posterior, posterolateral, or posteromedial), flexor hallucis longus pathologies, peroneal tendon problems, posterior tibial tendinopathy, Achilles tendon pathology, posterior subtalar tarsal coalition, or tarsal tunnel syndrome. Most of these pathologies can be managed effectively by an endoscopic approach. Read More

BMJ Open 2020 04 26;10(4):e035644. Epub 2020 Apr 26.

Department of Plastic-, Reconstructive- and Hand Surgery, Utrecht University Medical Center, Utrecht, The Netherlands.

Introduction: The peripheral nerves of patients with diabetes are often pathologically swollen, which results in entrapment at places of anatomical narrowing. This results in nerve dysfunction. Surgical treatment of compression neuropathies in the lower extremities (lower extremity nerve decompression (LEND)) results in relief of symptoms and gain in peripheral nerve function, which may lead to less sensory loss (short term) and less associated detrimental effects including foot ulceration and amputations, and lower costs (long term). Read More