What are the signs and symptoms of posterior tibial nerve entrapment?

Updated: Oct 15, 2019
  • Author: Minoo Hadjari Hollis, MD; Chief Editor: Thomas M DeBerardino, MD  more...
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Answer

Patients with proximal tarsal tunnel syndrome usually present with diffuse, vague discomfort or pain. They may have burning, tingling, or frank numbness in the plantar foot. Although occasionally a history of trauma is reported, most patients report an insidious onset of symptoms.

In most instances, symptoms are unilateral. Occasionally, patients may report proximal radiation of pain to the medial leg. Prolonged standing and walking usually exacerbate the symptoms, and rest alleviates them. Many patients also present with night pain that is improved with massage or walking. Patients may note pain secondary to nerve tension when the ankle is placed in extreme dorsiflexion.

Patients with distal entrapment of the lateral plantar nerve or its branches usually present with chronic heel pain that has been present for 9-12 months. Many of their symptoms are similar to plantar fasciitis, especially the location of their pain and their startup pain. In addition to the mechanical symptoms of plantar fasciitis, they present with neuritic pain that is unrelated to weight bearing or loading of the foot.

Most patients report that at first, their symptoms occurred only when they were bearing weight. Over time, the symptoms tended to increase, eventually occurring when the patient was seated and occasionally occurring at night.

Patients are usually asymptomatic in the mornings before taking their first step. Symptoms usually worsen with increased activity, as well as toward the end of the day and after long periods of standing, walking, or running. Prolonged standing in one place may be an aggravating factor. Most patients continue to have pain or burning (“afterpain” or “afterburn”) for 30 minutes to several hours after they are off their feet.

Tarsal tunnel syndrome is seen commonly in individuals who are in their fifth and sixth decades of life, and it is more common in women than in men. No consistent correlation with patient body weight has been identified. Most investigators have not been able to identify a significant common factor regarding occupation or underlying foot structure.

Some patients with tarsal tunnel syndrome have concomitant peripheral neuropathy or radiculopathy. Patients with peripheral neuropathy or radiculopathy may have symptoms that mimic tarsal tunnel syndrome.

Patients with certain systemic diseases, such as diabetes mellitus, alcoholism, thyroid disease, and vitamin deficiencies, are at increased risk for entrapment neuropathy.


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