Tarsal tunnel syndrome is a multifaceted compression neuropathy that typically manifests with pain and paresthesias that radiate from the medial ankle distally and, occasionally, proximally. These findings may have a variety of causes, which can be categorized as extrinsic, intrinsic, or tensioning factors in the development of signs and symptoms of tarsal tunnel syndrome.
Extrinsic causes may contribute to the development of tarsal tunnel syndrome. Examples include external trauma due to crush injury, stretch injury, fractures, dislocations of the ankle and hindfoot, and severe ankle sprains.
Local causes may be intrinsic causes of the neuropathy. Examples include space-occupying masses, localized tumors, bony prominences, and a venous plexus within the tarsal canal.
Nerve tension caused by a valgus foot can cause symptoms that are identical to those of a circumferential nerve compression.
Symptoms of tarsal tunnel syndrome vary from individual to individual, but clinical findings generally include the following: sensory disturbance that varies from sharp pain to loss of sensation, motor disturbance with resultant atrophy of intrinsic musculature, and gait abnormality (eg, overpronation and a limp due to pain with weight bearing).
A hindfoot valgus deformity may potentiate the symptoms of tarsal tunnel syndrome because the deformity may increase tension due to an increase in eversion and dorsiflexion.