TARSAL TUNNEL SYNDROMEDIAH MUSTIKA HW, SpS,KIC

Intensive Care Unit of Emergency Department

Navy Hospital Dr Ramelan Surabaya

Introduction

• Tarsal tunnel?

• Tarsal Tunnel Syndrome?

• Symptom?

• Causes/ etiologies?

• How to diagnosis?

• What is the treatment?

Tarsal tunnel

• A narrow space that lies on the inside of the ankle next tothe ankle bone.

• Covered by a thick ligament yi the flexor retinaculumprotect and maintains the structures within the tunnel

• One of these structures is the posterior tibial nerve.

Tarsal Tunnel SyndromeCompression or squeezing on the posterior tibial nerve

Tarsal Tunnel Syndromeimpingement & inflamation of the posterior tibial

nerve within the tarsal tunnel

SYMPTOMS

• Tingling, burning or sensation similar to an electric shock

• Pain, numbness or parasthesiaalong medial or plantar aspectof foot inside of the ankle, oron the bottom of the foot,maybe isolated,may extend to thethe heel,arch,toes,and calf

• may mimic plantar fasciitis- Onset Acute or chronic

ETIOLOGIES

Intrinsic Extrinsic

• Metabolic

• Toxic

• Crush

• Stretch

• Diabetes

• Mechanical

• Space – occupying masses

• Trauma

• Arthritis ridge

• Static or dynamic compression forces

Etiologies

• Pes Planus foot

• An enlarged or abnormal structures within the tunnel compress the nerve.

Exp : a varicose vein, ganglion cyst, swollen tendon, arthritic bone spur.

• An injury such as ankle sprain inflammation and swelling compression of the nerve

• Overweight prone to pressure on the posterior tibialnerve

• Systemic disease such as diabetes, arthritisswellingcompressing the nerve

Diagnosis

- Tinel’s sign

- Decreased sensationover nerve distribution

- MRI susp mass or initial

treatment fail

- EMG/NCV no improvement

with non surgical treatment

TREATMENT

Rest Ice NSAIDs Immobilization Physical therapy Injection therapy Orthotic devices Shoes Bracing Surgical release (in severe cases)