Tarsal tunnel syndrome (TTS) is an entrapment neuropathy caused by compression of the posterior tibial nerve or one of its branches. Despite being recognized much earlier, this debilitating condition was first labelled as a distinct foot pathology in the early 1960s and described as “pain in the proximal medial arch and paresthesia along the lateral and medial plantar nerves.” Paresthesia is the pins-and-needles prickling sensation that occurs due to nerve restriction. Although relatively rare, researchers suspect TTS is likely underdiagnosed as the symptoms mimic several other foot maladies.
Anatomy
The tibial nerve enters the foot behind the medial malleolus and under the fibrous flexor retinaculum. The flexor retinaculum, also known as the laciniate ligament, is a dense band of fascia that runs from the medial malleolus to the calcaneus covering and protects several flexor tendons, blood vessels, and nerves (Figure 1). The tarsal tunnel is the narrow conduit between the flexor retinaculum and the medial talus-calcaneus. It guides and protects the tibialis posterior, the flexor digitorum longus, the posterior tibial artery and vein, the tibial nerve, and the flexor hallucis longus, forming quite a bundle in a confined space. These can be recalled by the mnemonic “Tom, Dick, and very nervous Harry.”
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