The

BY CAPTAIN

Tarsal-Tunnel
CHARLES KECK,

Syndrome
Medical Hospital, Corps, Fort United Hood, SWiss Texa.s Army

From

the

United

States

Army

The syndrome attention

existence seen in the by Goldner

of

a

tarsal-tunnel

syndrome,

similar

to

the

carpal-tunnel

.

wrist and A review

unrelated to acute trauma, of the literature from 1932

was first called to my through 1960 revealed

that compression which has been The
tunnel

of the posterior tibial previously recognized case report illustrates

nerve in its fibro-osseous tuminel is an entity but not adequately stressed 1,2,4,5,6,7W the essential features of the tarsal-

following
syndrome.

REPORT

OF

A

CASE

Present
Fort
noted

Illness
States training
standing

A twenty-year-old white male recruit was admitted to the United Hood, Texas, on August 26, 1959. While in the fourth week of basic numbness over the plantar aspect of the toes and foot on prolonged
initially relieved progressed to his

Army Hospital, the patient first
and he
pain

walking.

Rest
numbness

symptoms,

but

complete

and needles”
Despite

and “burning”
bilateral symptoms

his

anesthesia. on the plantar he continued

with continued He described aspect of both
to carry

training
transient

over
episodes

a two-week
when
was

period,
had
present.

the
“pins

feet, but at no time
his recruit training.

on with

Past

History
in his
service.

The patient had always been in good health. He had played worked as a waiter for one year prior to his induction into the
of frost

high
There

school
was no

band
past

and

had

history

bite,

exposure

to

poison, of the feet.

familial

disease,

weakness

of the

upper

extremity,

diabetes,

leprosy,

or abnormalities

Physical
temperature

Examination weight
98.4
90

The patient’s
was

at admission
Fahrenheit:
diastolic.

was General

degrees

170 pounds; his height his pulse, seventy-two;
physical examination

was five feet, eleven respiration, twenty;
revealed a well

inches
and

his
blood well

pressure,

132 and

systolic,

developed,

nourished
structure posterior
except for

white

male.
alignment.

tibia!
digiti
nerve

pulses
quinti.

Inspection of the lower extremities revealed good muscles with normal foot Skin color, hair distribution, capillary circulation, and dorsalis pedis and were normal. A complete muscle test revealed normal tone and strength
interossei, lumbricales, complete anesthesia flexor over digitorum the sensory brevis, abductor of hallucis, the posterior and

non-functioning

abductor

There

was

distribution

tibia!
vascular
produced

(Figs.
cordlike

1-A,

1-B,
structure

and
localized

1-C).
just

Palpation
posterior to

of the medial
the medial

aspect

of the ankle
in the over region this

revealed
of the
was

a firm,
neuroarea within

longitudinal,

malleolus
proximally

bundle mild

with mild paresthesiae

in the

tenderness. soles of the

Percussion
feet.

indurated

General

neurological

examination

normal

limits.

Laboratory cent

Studies

Hematocrit was forty-five; white blood count was 9,150, with 70 per cent neutrophils, 27 per lymphocytes, 1 per cent eosinophils, and 2 per cent basophils. Sedimentation rate was zero. Total protein was 6.9 with albumin 4.4 and globulin 2.5 grams per 100 milliliters. Uric acid was 5.1 milligrams per 100 milliliters. Rheumatoid latex fixation test was negative. Serological test for syphilis was non-reactive. Fasting blood glucose was 107 milligrams per 100 milliliters. A urinalysis was within normal limits. Roentgenograms of the feet and chest were within normal limits.

Course

in the Hospital
to the

and
hospital,

Follow-up
the patient
was placed THE

On admission
180

on absolute
JOURNAL

bedrest. OF BONE

lie

received

whirlSURGERY

AND

JOINT

believe. veills A fusiform of constriction nerve appeared Just enlargement the entrance edematous of tile amid yellowish. after regimen of physical for his therapy legs. operative tunnel. posterior fibreTile found measured proximal Tile which and distal segments resembled to a point of the one centimeter a varicoecle. was A segment The the accomplished twenty-four open the power and the skin closed. This 44-A. tunnels medial mierve. .TilE TARSA L-TUNNEL SYNDROME 181 lJ(. was instituted Following a two-week in convalescent October leave.. osseous tii)ial roof point of muscles. were enlarged grossly with no change tibia! iii his on PllYsic:il each thigh condition l)umldle for at was over a period of one eighth anesthesia the the posterior neurovascular explored bilaterally a l)nellmatic same tourniquet bilaterally. and months COMMENT a progressive strengthening 22. hemostasis. dressof both within Immobilization Postoperatively and toes splints of sensation tenth plantar were within hours.. and 1-C: The distribuof complete anesthesia is indicated in black. Note in Fig. of the approximately tarsal tunnel. 1-A. I -Il Fm. 1. ill F’I(. 1-C the extent of the tion operative Posterior incision tihial for decompression nerve in the tarsal of the tunnel. Partial : normal of of the constriction. when the basic walking feet and was permitted. case report it is frequently diagnosed is one of a series of four NO.1959. 1-B. JANUARY 1962 . 1-A Figs. posterior There to were the four the tortuous malleolus posterior the Veins.. Stimulation point nerve two of both l)osterior. below-the-knee return produced point left plaster over motor and of tibia! enlarged was a weak constriction veins contraction was and removed was pressure aspect present proximal tarsal motor low response. . He The patient was discharged to full continues to remain asymptomatic training. to tunnels tile tortuous. roof. I-C pool week. un(ler til)ial Osseous constricted massage On The nerve tarsal the general was area to the lower hospital with findings extremities day. The consisting sensation on the forty-eight sutures removed massage on postoperative exercises and operation. completed day. with distal of fibrous patiemit the to tile each from roof by noted hours weme whirlpool duty eighteen by in lemigth. l)osterior tile entire constricted tii)ial fibrous cluster Both fibreof of decompressed longitudinal division Electrical the no after i)rOdUced stimulation intrinsic distal high ings.. The than foot VOL. tarsal-tunnel symidrome is an to entity which is probably more common as acute cases that the literature would lead one strain or plantar fascitis. ligation. feet and the nerve. fil)rous This of were the coincided acting compressed similar to portion a waist of the of cincher.

1946. R. T. 4. K. REFERENCES 1. since to control their symptoms by voluntary restriction finding in this or nerve-trunk present. 1948. Med. Extremity. for the Texas. 6. seen. Rest pain. G. H.. British J. and THOMPSON.182 have been approximately these the entity frequently the patients of activity. 1946. Am. Neurosurg.. W.. A. J. J. FAHLUND. L. GOLDNER. type recognized 2. L. was not observed. 5. it occurs more syndrome literature is commonly would lead misdiagnosed one to believe. and DAVIS.. J. : Posterior Tibia! Nerve Injuries. CLARK. : Peripheral Nerve Injuries Associated with Fractures. POLLOCK. 14: 124-129... with 27: 476-479. The Valleix phenomenon. which has been described as a frequent significant of neuropathy.. : Peripheral Entrapment Neuropathies of the Lower New England J.500 are this in CHARLES KECK during recruits presumably a period receive in good In of two years basic training health at Fort Hood. 3. Surg. was SUMMARY A case in a twenty-year-old report illustrating white male the essential army recruit and features that of the tarsal-tunnel It is assumed frequently syndrome that than this the is described. Southern Surgeon. a Follow-up 1960. P. 1960. : Personal communication. 18: 361-401. : Suture of the Posterior Study of the Clinical Results. Tibial Nerve Below 3: 223-233. Med. this syndrome are better able a civilian practice. 1932. 7. C. the Knee. THE JOURNAL OF BONE AND JOINT SURGERY . each month. \V. 33: 382-385. Postgrad. : Suture of the External and Internal Popliteal Nerves. tenderness proximal and distal to the area of compression. where The fact that low incidence of inductees accounts age group. L. 2. WARD. 262: 56-60. J. KOPELL. Surg. where poor foot structure is is probably more common but less dramatic. LOYAL: Peripheral Nerve Injuries. ROAF. R.