Plantar fasciitis, entrapment neuropathies, and tarsal tunnel syndrome: current up to date treatment

Tarsal tunnel syndrome (TTS), resulting from compression of the posterior tibial nerve (PTN) within the tarsal tunnel, is a relatively uncommon entrapment neuropathy. Many cases of tarsal tunnel syndrome are idiopathic; however, some causes, including space-occupying lesions, may lead to occurrence of TTS symptoms. Schwannoma, the most common tumor of the sheath of peripheral nerves, is among these space-occupying lesions, and may cause TTS when it arises within the tarsal tunnel, and it may mimic TTS even when it is located outside the tarsal tunnel and cause a significant delay in diagnosis. The possibility of an occult space-occupying lesion compressing the PTN should be kept in mind in the differential diagnosis of TTS, and imaging studies that are usually not used in entrapment neuropathies may be of importance in such patients. This case report presents a 65-year-old woman with TTS symptoms and neurophysiologic findings secondary to an occult schwannoma of the PTN proximal to the tarsal tunnel. Avoidance of delay in diagnosis in secondary cases is emphasized.

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Biomechanical Evaluation of Two Clinical Tests for Plantar Heel Pain: The Dorsiflexion-Eversion Test for Tarsal Tunnel Syndrome and the Windlass Test for Plantar Fasciitis

Fuß & Sprunggelenk ◽

10.1016/s1619-9987(08)60426-2 ◽

2007 ◽

Vol 5 (3) ◽

pp. 227

Author(s):

Harald Kuhn ◽

Manfred Thomas

Keyword(s):

Plantar Fasciitis ◽

Heel Pain ◽

Tarsal Tunnel ◽

Tarsal Tunnel Syndrome ◽

Clinical Tests ◽

Plantar Heel Pain ◽

Tunnel Syndrome ◽

Biomechanical Evaluation

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Results of Surgery in Athletes with Plantar Fasciitis

Foot & Ankle ◽

10.1177/107110078600700305 ◽

1986 ◽

Vol 7 (3) ◽

pp. 156-161 ◽

Cited By ~ 113

Author(s):

Robert E. Leach ◽

Mitchell S. Seavey ◽

Daniel K. Salter

Keyword(s):

Plantar Fasciitis ◽

Conservative Therapy ◽

Plantar Fascia ◽

Tarsal Tunnel ◽

Tarsal Tunnel Syndrome ◽

Athletic Activity ◽

Common Cause ◽

Tunnel Syndrome ◽

Cause Of Pain ◽

Results Of Surgery

Plantar fasciitis is a common cause of pain, particularly in runners and certain other athletic groups. This syndrome must be distinguished from certain other conditions, such as the tarsal tunnel syndrome and achillodynia. Conservative therapy including rest, orthotics, heel cups, anti-inflammatory agents, and icing reduce symptoms in most patients. A few athletes may need surgery to continue running. The authors released the plantar fascia and excised areas of mucinoid degeneration in 15 athletes. Fourteen returned to full athletic activity.

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Assessment of the frequency of tarsal tunnel syndrome in rheumatoid arthritis

Turkish Journal of Physical Medicine and Rehabilitation ◽

10.5606/tftrd.2021.6797 ◽

2021 ◽

Vol 67 (4) ◽

pp. 421-427

Author(s):

Mehtap Kalçık Ünan ◽

Özge Ardıçoğlu ◽

Nevsun Pıhtılı Taş ◽

Rabia Aydoğan Baykara ◽

Ayhan Kamanlı

Keyword(s):

Rheumatoid Arthritis ◽

Short Form ◽

Health Assessment ◽

Walking Distance ◽

Control Group ◽

Tarsal Tunnel ◽

Tarsal Tunnel Syndrome ◽

Das28 Score ◽

Entrapment Neuropathies ◽

Tunnel Syndrome

Objectives: In this study, we aimed to determine the frequency of tarsal tunnel syndrome (TTS) in rheumatoid arthritis (RA) patients. Patients and methods: Thirty RA patients (1 male, 29 females; mean age: 41.9±10.1 years; range, 26 to 65 years) who met the American College Rheumatology (ACR) classification criteria and 20 healthy volunteers (1 male, 19 females; mean age: 39.3±10.8 years; range, 26 to 60 years) without any complaints between August 2006 and October 2007 were included in the study. Demographic characteristics of the study group were assessed and neurological examinations were performed. The Tinel’s sign was checked to provoke the TTS symptoms. Disease severity was measured using Visual Analog Scale (VAS), Disease Activity Score-28 (DAS28), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The health-related quality of life and disability status were determined using the Health Assessment Questionnaire (HAQ), Short Form 36 (SF-36), Foot Function Index (FFI), and VAS (0-100 mm). The positional relationship of the foot pain was questioned with VAS. The 100-m walking distance of the patient and control groups were calculated. Results: Bilateral TTS was detected in 10 of the patients (33.3%) with rheumatoid arthritis. No relationship with the TTS disease duration, seropositivity, rheumatoid nodule, joint deformities, corticosteroid use, and DAS28 score were found. In correlation with TTS, foot and ankle joint were the first involved joints at the beginning of RA disease (p<0.005). The Tinel’s sign was found to be 45% positive in patients with TTS. The 100-m walking time was significantly longer in RA patients compared to the control group (p<0.0001). Conclusion: Tarsal tunnel syndrome is commonly seen in RA and its incidence increases in patients with primary foot involvement. Therefore, caution should be taken against the entrapment neuropathies in these patients, and they should be supported by electrophysiological practices, when the diagnosis is necessary.

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Heel Pain Triad (HPT): The Combination of Plantar Fasciitis, Posterior Tibial Tendon Dysfunction and Tarsal Tunnel Syndrome

Foot & Ankle International ◽

10.1177/107110070202300305 ◽

2002 ◽

Vol 23 (3) ◽

pp. 212-220 ◽

Cited By ~ 32

Author(s):

Sameh A. Labib ◽

John S. Gould ◽

Felix A. Rodriguez-del-Rio ◽

Stephen Lyman

Keyword(s):

Plantar Fasciitis ◽

Heel Pain ◽

Posterior Tibial Tendon ◽

Tarsal Tunnel ◽

Tarsal Tunnel Syndrome ◽

Posterior Tibial Tendon Dysfunction ◽

Posterior Tibial ◽

Tunnel Syndrome

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Case 6

10.1093/med/9780190603434.003.0010 ◽

2018 ◽

Author(s):

Bashar Katirji

Keyword(s):

Plantar Fasciitis ◽

Tibial Nerve ◽

Nerve Conduction Studies ◽

Accurate Diagnosis ◽

Tarsal Tunnel ◽

Foot Pain ◽

Tarsal Tunnel Syndrome ◽

Peripheral Polyneuropathy ◽

Common Causes ◽

Tunnel Syndrome

Tarsal tunnel syndrome is relatively rare entrapment syndrome, and should be considered in patients with foot pain or numbness. It is the result of compression or entrapment of the tibial nerve or any of its three terminal branches under the flexor retinaculum. This case discusses a patient with typical manifestations of tarsal tunnel syndrome and highlights its causes, differential diagnosis and electrodiagnostic findings. It also covers the challenges in making an accurate diagnosis in view of the technical difficulties encountered with foot and sole nerve conduction studies. Tarsal tunnel syndrome is often overdiagnosed, since it may be confused with other more common causes of foot pain and numbness including plantar fasciitis, peripheral polyneuropathy, and S1 radiculopathy.

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