Tarsal Tunnel

Musculoskeletal disorders are disorders of the muscles, nerves, tendons, ligaments, joints, cartilage and spinal discs not caused by slips, trips, falls, motor vehicle accidents or other similar accidents. Examples are carpal tunnel syndrome, rotator cuff syndrome, De Quervain s disease, trigger finger, tarsal tunnel syndrome, sciatica, epicondylitis, tendinitis, Raynaud s phenomenon, carpet layers knee, herniated spinal disc, and low back pain. 

Pillen S, Scholten RR, Zwarts MJ et al (2003) Quantitative skeletal muscle ultrasonography in children with suspected neuromuscular disease. Muscle Nerve 27 699-705 Pla ME, Dillingham TR, Spellman NT et al (1996) Painfiil legs and moving toes associated with tarsal tunnel syndrome and accessory soleus muscle. Mov Disord 11 82-86... 

Sammarco GJ, Stephens MM (1990) Tarsal tunnel syndrome caused by flexor digitorum accessorius longus J Bone Joint Surg Am 72 453-454... 

Lee MR Chan PT, Chau LF et al (2002) Tarsal tunnel syndrome caused by talocalcaneal coalition. Clin Imaging 26 140-143 Leekam RN, Voorneveld CR (1996) Synovial osteochondromatosis of the distal radioulnar joint ultrasound diagnosis. J Clin Ultrasound 24 207-208... 

The posterior tibial artery is the direct continuation of the popliteal artery down to the distal margin of the popliteus muscle. During its course, this artery is accompanied by the tibial nerve and two or more posterior tibial veins. This posterior neurovascular bundle passes deep to the tendinous arch of the soleus and, after giving off the peroneal artery, courses superficial to the tibialis posterior muscle to reach the tarsal tunnel (Fig. 15.12a,b). The posterior tibial artery is a useful landmark to separate the deep from the superficial group of calf... 

At the medial ankle, the tibial nerve, a continuation of the medial trunk of the sciatic nerve, passes deep to the flexor retinaculum in the space between the medial malleolus and the medial wall of the calcaneus (Fig. 16.10a). The retinaculum consists of a thin fascia and forms the roof of the tarsal tunnel (Fig. 16.10). In addition to the nerve, the tarsal tunnel encloses the tibialis posterior, flexor digitorum longus and flexor hallucis longus tendons, the posterior tibial artery and two veins (Fig. 16.10a,b). Posteroinferior to the medial malleolus, the tibial nerve divides into the medial and lateral plantar nerves and the calcaneal nerve, which is responsible for the sensitive supply of the heel (Fig. 16.11). The plantar nerves supply the intrinsic foot muscles, except for the extensor digitorum brevis, which is innervated by the deep peroneal nerve. The posterior tibial artery accompanies the nerve deep to the flexor retinaculum and, inferior to the medial malleolus, it divides into medial and lateral plantar arteries (Fig. 16.11). 

Fig.16.11. Normal tibial nerve at the tarsal tunneL Gross dissection of the tarsal tunnel gives a closer look to the tibial nerve (arrows) and its divisional branches, the medial (1) and lateral (2) plantar nerves, and the calcaneal branches (arrowheads), a, posterior tibial artery. The insert on the left of the figure indicates the site of the anatomic specimen illustrated...

With high-resolution transducers, US can delineate the complex anatomy of the tarsal tunnel and... 

Fig. 16.30 a,b. Normal tarsal tunnel, a Transverse 12-5 MHz US image obtained posterior to the medial malleolus (MM) demonstrates the tibial nerve (arrow) located close to the posterior tibial artery (a) and veins (v) and posterior to the tibialis posterior (tp) and flexor digitorum longus (fdl) tendons. All these structures lies in the tarsal tunnel and are covered by the flexor retinaculum (arrowheads), b Oblique transverse 12-5 MHz US scan at the medial heel shows the medial and lateral plantar nerves (arrows) as a result of division of the main trunk of the tibial nerve. The photographs at the upper left of the figures indicate probe positioning... 

Tarsal tunnel syndrome refers to the entrapment of the main trunk of the tihial nerve and/or of its divisional branches (medial plantar nerve, lateral plantar nerve, calcaneal nerve) at the medial aspect of the ankle. This syndrome has an insidious clinical onset with numbness or pain in the foot and ankle and paresthesias in the sole of the foot, often with the heel being spared. However, clinical and electromyographic diagnosis of tarsal tunnel syndrome is often not straightforward, especially when a soft-tissue swelling on the medial ankle is absent. Depending on the site of compression, tarsal tunnel syndrome produces different clinical syndromes that can be classified as proximal or distal. The proximal syndrome consists of entrapment of the main trunk of the tibial nerve in the... 

Soft-tissue masses in the ankle are uncommon (OzDEMiR et al. 1997). They may he asymptomatic or may cause disturbances, such as pain, weakness, swelling, joint impairment or tarsal tunnel syndrome. With US, the diagnosis of a solid or complex mass versus a cystic mass can reliably be performed in the soft tissue of the ankle. The US characteristics of many masses that arise around the ankle joint are reported in the General Section of this book. However, the specific features of some of them, including ganglia, neurogenic tumors and abscesses, warrant additional brief discussion here. Accessory muscles (peroneus quartus, flexor digitorumlongus accessorius, accessory soleus) have already been described in previous sections of this chapter. 

Tarsal-tunnel syndrome idiopathic or following ankle fractures... 

Tarsal tunnel syndrome, idiopathic or post ankle fracture... 

Internal derangement of the knee Patellar bursitis Tarsal tunnel syndrome Plantar fascitis. 

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