Tarsal tunnel syndrome

Tarsal tunnel syndrome

• 1.
  TARSAL TUNNEL SYNDROME SUHAIL AP
• 2.
  INTRODUCTION  Compression neuropathyof posterior tibial nerve  TARSAL TUNNEL – contents ◦ tibialis posterior ◦ Flexor digitorum longus ◦ Posterior tibial artery and vein ◦ POSTERIOR TIBIAL NERVE ◦ Flexor hallucis longus
• 3.
   Posterior tibialnerve – medial plantar nerve, lateral plantar nerve, calcaneal br.
• 4.
  CLINICAL FEATURES  Mostcommon in middle aged females  Pain and burning sensation- localised posterior and inferior to medial malleolus  Numbnes  Pain worsens with activity and later rest pain
• 5.
   No localsigns of inflammation  Point tenderness over soft spot on medial border of ABDUCTOR HALLUCIS  VALLEIX Test positive  Tinels sign +  Two point discrimination
• 6.
  Point tenderness overthe soft spot on the medial border of the abductor hallucis.
• 7.
  ETIOLOGY  INTRINSIC FACTORS Tendonopathies  Osteophytes  Accessory muscles  Ganglia  Lipomas
• 8.
   EXTRINSIC FACTORS Trauma  Foot malformations  Constrictive footwear  Oedema  Iatrogenic TTS
• 9.
  DIAGNOSIS  Clinical diagnosis Tinels test  Dorsiflexion eversion test  Valleix test  X ray  MRI  MRN  US  EMG  NCS
• 11.
  Treatment  NON OPERATIVE Activity modification  Medications – NSAIDS and Gabapentin  Nerve mobilisation excercises  Night Splints  Orthotic inserts
• 12.
   OPERATIVE Curved medialincion over tarsal tunnel Release of Post Tibial Nerve in TT Success rate -71%