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Posterior Tarsal Tunnel Syndrome

A few weeks ago we introduced you the structures that run through the inner side of our ankle, which is commonly known as “Tom, Dick And Not Harry”. Let’s have a quick recap.

Tom Dick And Not Harry

T – Tibialis posterior tendon – responsible for plantarflexion, inversion, and supporting the medial arch

D – flexor Digitorum longus tendon – responsible for flexing the toes

A – posterior tibial Artery/vein – supplies blood and nutrients to the plantar surface

N – tibial Nerve - supplies the plantar surface

H – flexor Hallucis longus tendon – responsible for flexing the big toe

This week we will talk about the syndrome that is related to these structures if they get compressed. As we have mentioned, these structures run along the inner side of our ankle in a tiny space called the posterior tarsal tunnel. The tarsal tunnel is covered by a strong fibrous tissue, known as the flexor retinaculum, that holds these structures in place.

If this tissue becomes inflamed, swollen, or fibrotic, Tom, Dick AND Not Harry will become irritated or compressed, causing symptoms down the plantar side of the foot. This is called the posterior tarsal tunnel syndrome.

Symptoms include:

- Burning

- Tingling

- Numbness in heel, medial and lateral forefoot

- Worse with weight bearing

This syndrome might be related to the overpronation of the foot causing an increased tautness of the flexor retinaculum. Orthotics might be beneficial to people with this syndrome as it can reduce the overpronation and hence reduce the tautness of the flexor retinaculum.

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