How is posterior tibial nerve entrapment diagnosed?

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

The diagnosis of posterior tibial nerve entrapment, or tarsal tunnel syndrome (proximal and distal), is based primarily on a detailed history and physical examination. Further screening studies (eg, laboratory workup for arthritides, diabetes, alcoholism, and thyroid dysfunction) are indicated in cases of associated inflammation and in patients with symptoms of peripheral neuropathy (see Workup).

Inspection of the patient while he or she is standing and walking allows the examiner to evaluate for alignment deformities, such as hindfoot varus or valgus, swelling, varicosities, or other skin changes.

Palpation of the pulses is used to evaluate the patient’s distal circulation. Sensory examination, including Semmes-Weinstein monofilament testing of the entire foot, may reveal dermatomal numbness due to compression neuropathy, or could reveal peripheral neuropathy.

The range of motion of the ankle, subtalar, and the midfoot joints is examined, and any limitations are noted. Pain may increase with dorsiflexion and eversion or inversion of the foot; these positions increase tarsal compartment pressure. [28] Motor examination should include asking the patient to spread the toes to facilitate assessment of the abductor digiti minimi and, if appropriate, the abductor hallucis. Hypertrophy of the abductor hallucis or an accessory muscle may also be present, with fullness in the longitudinal arch.


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