How To Address Ganglionic Cysts In The Tarsal Tunnel

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Dina Stock, DPM, Cory Baxter, DPM, James Sferra, MD, Christopher Herbert, DPM, and Elizabeth Baracz, BS

Tarsal tunnel syndrome is an entrapment of the posterior tibial nerve or its branches within the tarsal tunnel.1 This syndrome is most frequently unilateral as opposed to carpal tunnel syndrome in the upper extremity, which is typically bilateral.2 Keck and Lam first described the term “tarsal tunnel syndrome” in 1962.3,4
Malaisé first described the clinical signs and symptoms of tarsal tunnel syndrome in 1918. Some of the symptoms include numbness or tingling in the soles of the feet and toes or a burning pain in the ankles.5 A sensation of tightness, cramping pain and worsening of symptoms with prolonged standing have all been associated with tarsal tunnel syndrome.6
Diagnosing this syndrome can be difficult as the symptoms of nerve compression are described in a vague way and may mimic other pathologies of the foot and ankle. Often the patient’s own misconception of his or her multiple foot problems adds to the difficulty.7 Adjunctive methods often aid in both diagnosing the syndrome and differentiating the etiology.
When it comes to proper treatment, the etiology of tarsal tunnel syndrome is just as important as making the correct diagnosis. Using both nerve conduction velocity (NCV) testing and visualizing the area with either ultrasonography or magnetic resonance imaging (MRI) can be key in the physician’s ability to apply the appropriate treatment plan. Magnetic resonance imaging clearly depicts bones, soft tissue and boundaries of the tarsal tunnel, and can often reveal the specific pathology responsible for tarsal tunnel syndrome. This modality easily shows lesions of the synovial sheath, varicose veins and ganglions, which may all present in the tarsal tunnel and can cause the syndrome.1

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