Tarsal tunnel syndrome involves heel and foot pain due to compression of the posterior tibial nerve as it courses inferior to the medial malleolus. Causes include running, restrictive footwear, edema of pregnancy, posttraumatic fibrosis, ganglion cysts, osteophytes, and tumors. Pain is worse at night and located at the medial malleolus, the heel, the sole, and the distal calf.
The differential diagnosis includes plantar fasciitis and Achilles tendonitis. Tinel sign is positive, and eversion and dorsiflexion worsen symptoms. The pain of tarsal tunnel syndrome involves the more medial heel and arch and worsens with activity. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) may aid in diagnosis. Treatment includes NSAIDs, rest, and possible orthopedic referral.
Deep Peroneal Nerve Entrapment
Entrapment of the deep peroneal nerve occurs most frequently where it courses beneath the extensor retinaculum. Recurrent ankle sprains, soft tissue masses, and restrictive footwear represent the most common causes. Symptoms include dorsal and medial foot pain as well as sensory hypoesthesia at the first web space.
Pain and tenderness can be elicited by plantar flexion in inversion of the foot. Plantar fasciitis should also be considered. Ultrasound, CT, and MRI may aid in diagnosis. Treatment includes NSAIDs, rest, and possible orthopedic referral.