Abstract:Tarsal tunnel syndrome is an uncommon entrapment neuropathy involving the posterior tibial nerve and/or its distal branches in the region of the medial ankle and foot. The etiology is often multifactorial, with trauma a contributing factor in more than 50% of patients. Signs and symptoms of tarsal tunnel syndrome are often confused with other conditions; the differential diagnosis includes lumbosacral radiculopathy, calcaneodynia, metatarsalgia, rheumatoid arthritis, plantar fasciitis, peripheral neuropathy, peripheral vascular disease, and Morton's neuroma. Treatment begins with the identification and removal of any repetitive local trauma, followed by the application of a medial arch support. Use of oral antiinflammatories and local steroid injection may be helpful. If conservative management fails, surgical decompression is indicated. A working knowledge of the anatomy of the tarsal tunnel is necessary to perform a thorough and safe posterior tibial, medial and lateral plantar and calcaneal nerve decompression. With surgery, 75% of patients can be expected to have significant improvement. Patients with space-occupying lesions generally do best; those who have undergone previous surgery, have a diagnosis of plantar fasciitis, or have an associated autoimmune disorder do less well.