Orthonotes
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Tarsal Tunnel Syndrome

Entrapment neuropathy of the posterior tibial nerve under the flexor retinaculum behind the medial malleolus. Symptoms: burning dysesthesia/paresthesia in plantar foot, worse at night or with prolonged standing; positive Tinel’s sign posterior to medial malleolus. Etiologies: space‑occupying lesions (ganglion, varicosities), tenosynovitis, trauma, hindfoot valgus/flatfoot causing traction, systemic neuropathies. NCS/EMG supports diagnosis; ultrasound/MRI detects masses and tendon pathology. Treatment: correct biomechanics (orthoses), NSAIDs, treat masses; surgical decompression with release of flexor retinaculum and distal tunnel when conservative measures fail.

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Entrapment neuropathy of the posterior tibial nerve under the flexor retinaculum behind the medial malleolus. Symptoms: burning dysesthesia/paresthesia in plantar foot, worse at night or with prolonged standing; positive Tinel’s sign posterior to medial malleolus. Etiologies: space‑occupying lesions (ganglion, varicosities), tenosynovitis, trauma, hindfoot valgus/flatfoot causing traction, systemic neuropathies. NCS/EMG supports diagnosis; ultrasound/MRI detects masses and tendon pathology. Treatment: correct biomechanics (orthoses), NSAIDs, treat masses; surgical decompression with release of flexor retinaculum and distal tunnel when conservative measures fail.
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