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Tarsal Tunnel Syndrome:: A Clinical Management Guideline
Tarsal Tunnel Syndrome:: A Clinical Management Guideline
Bottom Line Summary The entrapment of the posterior tibial nerve leading to Tarsal Tunnel Syndrome can be caused by a variety of intrinsic and extrinsic factors. Currently, management for TTS includes conservative and surgical interventions that pose minimal complications and positive outcomes. However, the prognosis of TTS is still dependent on the identification of the mechanism of peripheral nerve compression and the influence of comorbidities.
Evidence-Supported Interventions 7: Conservative Management: pain medications, corticosteroids, non-steroidal anti-inflammatories (NSAIDs) Physical Therapy Management o In the acute stage: Initially reduce inflammation, tissue stress, and pain using physical agents, orthotics and taping, therapeutic exercise and manual therapy o In the subacute stage: Improve strength and flexibility of the posterior tibialis muscle o In the settled stage: Improve functional mobility, strength in weight bearing, and flexibility bilaterally in the posterior tibialis muscle Surgical management can include posterior tibial nerve decompression and cryosurgery o Following surgery, post-surgical physical therapy will be needed.
Some helpful clinical tests include palpation over the flexor retinaculum (Fig. 1) or Tinel Sign, which is performed by tapping over the nerve attempting to change or reproduce symptoms5. The dorsiflexion-eversion test and the inversion test may also both increase symptoms. When dorsiflexing and everting the foot tension is placed on the nerve, and when inverting the foot the volume of the tarsal tunnel is decreased; either of these tests can reproduce pain or increase symptoms. Some differential diagnoses that should be considered include polyneuropathy, radiculopathy, deep flexor compartment syndrome, Mortons Metatarsalgia, and plantar fasciitis5, 6. The most common and most probable misdiagnosis is plantar fasciitis.
PT7549, 2012
August 5, 2012 PT7549 Author: Brandon Plyler, Maiela Martinez, Caleb Melde, Matt Gieringer
References
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