Tarsal Tunnel Syndrome and Its Surgical Treatment

Description: The tarsal tunnel is a fibro-osseous space located posterior to the medial malleolus. Several structures pass through this space, including the posterior tibial nerve, the posterior tibial artery and vein, and the tendons of the flexor hallucis longus, flexor digitorum longus, and posterior tibial muscles. The tarsal tunnel is bordered by the tibia anteriorly and the talus and calcaneus laterally. Medially it is covered by the flexor retinaculum. The flexor retinaculum, also referred to as the lacinate ligament, is contiguous with the crural fascia proximally. Tarsal tunnel syndrome is an entrapment neuropathy of the tibial nerve or one of its branches as it passes through the tarsal tunnel. Potential causes of tarsal tunnel syndrome include trauma, varicosities, tenosynovitis, space-occupying lesions, and hindfoot deformity; however, in many cases the aetiology is idiopathic [1-4]. It is also important to note that compression of one of the distal branches of the nerve as they pass deep to the abductor hallucis muscle can produce symptoms similar to those caused by proximal compression within the tarsal tunnel proper [5]. Compared with carpal tunnel syndrome, tarsal tunnel syndrome is much less common. One possible explanation for this is the fact that the tarsal tunnel is wide and shallow. Further, it is covered by a thin retinaculum making it a more compliant space than the carpal tunnel.
Samrendu K. Singh FRCS (ORTH), Michael G. Wilson M.D. and Christopher P. Chiodo M.D. The Orthopaedic Journal at Harvard Medical School Vol 7