Tibial Nerve Is the Medial Component of the Sciatic Nerve

Tarsal Tunnel Syndrome

Normal Anatomy

· Tibial nerve is the medial component of the sciatic nerve

· Tibial nerve comes to the surface at the level of the medial side of the ankle

· Enters the tarsal tunnel between the medial malleolus and achilles tendon with the posterior tibial artery and vein

· Tarsal Tunnel is an osteofibrous canal covered by the flexor retinaculum

· Tibial nerve splits in the Tarsal Tunnel into the medial and lateral plantar nerves

Pathology

· Irritation of the peripheral nerve within the Tarsal Tunnel

Mechanism of Injury

Insidious

· Space occupying lesions

· Repetitive stress through running or walking

· Muscle and Tendon Hypertrophy

· Excessive weight

· Rheumatoid Arthritis

Traumatic

· Fractures

· Dislocation

· Ligament sprains

Examination

Subjective

· Tingling or numbness around the medial ankle and plantar surface of the foot

· Pain with prolonged standing or walking

· Burning sensation at night

Objective

· Pain on palpation of the nerve on the medial ankle

· Painful sustained dorsiflexion plus eversion

· Loss of sensation medial aspect of the foot

· Reduced power of the toe abductors and flexors

· Percussion of posterior tibial nerve causes paraesthesia

Further Investigations

· Electrophysiological testing (Nerve Conduction Velocity testing)

· X-ray

· MRI

Management

· Goal of management to reduce the compression within the tarsal tunnel

Conservative

· Reduce pain and inflammation

o Ice

o NSAID’s

o Orthotics

o Night Splints

o Taping

o Massage

· Restore Normal Range of Movement

o Ankle and Foot

§ Soft tissue massage

§ Foam rolling

§ Stretching

§ Dry needling

§ Joint mobilisations

§ Joint manipulations

§ Neurodynamic mobilisations

· Restore Normal Muscle Activation

o Intrinsic foot muscles

Plan B

· Corticosteroid Injection

· Surgical decompression

References

(Antoniadis and Scheglmann 2008, Hudes 2010, Ahmad, Tsang et al. 2012)

Ahmad, M., K. Tsang, P. J. Mackenney and A. O. Adedapo (2012). "Tarsal tunnel syndrome: A literature review." Foot Ankle Surg 18(3): 149-152.

Antoniadis, G. and K. Scheglmann (2008). "Posterior Tarsal Tunnel Syndrome: Diagnosis and Treatment." Dtsch Arztebl Int 105(45): 776-781.

Hudes, K. (2010). Conservative management of a case of tarsal tunnel syndrome. J Can Chiropr Assoc. 54: 100-106.