Tarsal tunnel syndrome
 Discussion of Tarsal tunnel syndrome
- The tarsal tunnel is a fibro-osseous canal that is bounded by the flexor retinaculum superficially and the medial surfaces of the talus and calcaneus on its deep surface.
- It contains the posterior tibial nerve, the three medial tendons (posterior tibial, flexor digitorum longus, flexor hallucis longus), and the posterior tibial artery and posterior tibial vein.
- Tarsal tunnel syndrome is an entrapment neuropathy of the posterior tibial nerve or of its branches within the tarsal tunnel.
- The most common symptoms are pain and paresthesias in the toes, sole, or heel.
- The main finding at physical examination is the Tinel sign (distal paresthesias produced by percussion over the affected portion of nerve).
- Electromyography and nerve conduction studies are useful in confirming the diagnosis.
- Etiologies of tarsal tunnel syndrome.
- Bone deformity after calcaneal fractures
- Tenosynovitis of the flexor tendons
- Accessory or hypertrophied abductor hallucis muscle
- Synovial hypertrophy
 Imaging Findings for Tarsal tunnel syndrome
- MR imaging clearly depicts the bones, soft-tissue contents, and boundaries of the tarsal tunnel as well as the different pathologic conditions responsible for tarsal tunnel syndrome.
- MR imaging can also aid in determining whether treatment should be conservative (eg, tenosynovitis) or surgical (eg, for space-occupying lesions).
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 References for Tarsal tunnel syndrome
- José A. Narváez, Javier Narváez, Raúl Ortega, Carlos Aguilera, Ana Sánchez, and Eduard Andía. Painful Heel: MR Imaging Findings. RadioGraphics 2000 20: 333-352.