Which physical findings suggest posterior tibial nerve entrapment?

Updated: Oct 15, 2019
  • Author: Minoo Hadjari Hollis, MD; Chief Editor: Thomas M DeBerardino, MD  more...
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Patients with proximal tarsal tunnel syndrome often have ganglia, tenosynovitis, or other space-occupying lesions in the tarsal tunnel that may be palpable. They may also have positive Tinel signs along the posterior tibial nerve. Occasionally, nerve percussion causes symptoms and pain to radiate proximal to the nerve course (the so-called Valleix phenomenon). Linscheid noted that in most of his patients with proximal tarsal tunnel syndrome, manual compression of the nerve at the tarsal tunnel for 60 seconds reproduced their symptoms. [38]

Patients with distal tarsal tunnel syndrome usually have the most severe tenderness over the first branch of the lateral plantar nerve over the plantar medial heel and under the abductor hallucis. Many patients have tenderness along the entire posterior tibial nerve, starting from behind the distal medial malleolus. Additional tenderness is usually present over the plantar fascia insertion on the medial calcaneal tuberosity and sometimes along the entire medial edge of the plantar fascia. The Tinel sign is usually absent.

The deep tendon reflexes and straight-leg raise are evaluated with an eye to detecting any isolated or concomitant radiculopathy. Hamstring tightness is evaluated with both legs extended.

Patients with entrapment of the medial plantar nerve have tenderness over the medial arch inferior to the navicular tuberosity, but not directly over the plantar fascia. Pain may radiate to the medial toes and the ankle. Numbness or a Tinel sign over this area may be present only after prolonged weightbearing exercise. Occasionally, orthotic use may be correlated with the onset of the symptoms. Stretching of the nerve as a result of eversion of the foot or of standing on the toes may reproduce or exacerbate symptoms.

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