Tarsal tunnel syndrome in sport

Abstract

Tarsal tunnel syndrome is an entrapment neuropathy of the posterior tibial nerve or its terminalbranches as they pass into the foot through a fibro osseous tarsal tunnel below andbehind the medial malleolus.It presents with pain and paraesthesia, or numbness in the distribution of the posteriortibial nerve. The diagnosis generally requires a positive Tinel's sign and positive electrophysiologicalstudies.In the athletic individual TTS tends to be associated with running, jumping or impactsports. It has been assossiated with tarsal coalitions, accessory muscles and planovalgusfoot deformity.Treatment includes conservative measures such as ice, anti inflammatory medication,orthotics and modified activity. Surgical decompression needs to include the entire distaltarsal tunnel. The timing of surgery is controversial, but there is a strong body of evidenceto suggest that earlier decompression avoids permanent nerve damage and fibrosis.