CASE REPORT   

Chirurgia Del Piede 2000 March;24(1):63-86

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: Italian

Tarsal tunnel syndrome. Revision of the literature and description of two unusual cases

Causero A., Giglio G., Campailla E., Cum M., Paschina E.

The authors describe two unusual cases of tarsal tunnel syndrome. The first concerned a professional football player who complained of intense pain and paresthesia affecting the zone of the posterior tibial nerve. In view of the patient's professional activities, and although the symptoms already strongly suggested tarsal tunnel syndrome, it was decided to carry out further instrumental diagnostic tests to exclude plantar fascitis. EMG showed a picture that was compatible with the clinical diagnosis, whereas MRI was negative. CT was then performed and confirmed the presence of astragalus exostosis. The second case concerned a 68-year-old woman who had complained for about 4 years of pain localised in the 1st ray, particularly when walking, and «shock» type pain starting from the tarsal tunnel and radiating distally in correspondence with the 1st ray and proximally to the 3rd distal portion of the leg. The patient underwent EMG which showed an initial conduction block of SPI in the ankle, followed by MRI to complete the diagnostic process, which confirmed the presence of a rounded formation measuring approximately 15 mm in the tunnel, dislocating the tibial neurovascular fascia to the rear. The two patients underwent surgical neurolysis of the posterior tibial nerve leading to the complete resolution of symptoms. In the first case, a voluminous exostosis compressing the nerve was removed, and in the second the neoformation, of a soft-elastic consistency, was localised between the medial and side branches at the bifurcation of the posterior tibial nerve.