Le syndrome du canal tarsien par lipome compressif chez le sportif

Abstract

ObjectiveTo report the diagnosis and the etiological context of tarsal tunnel syndrome and demonstrate the utility of surgery in the management of this syndrome.MethodsDescription of a case of tarsal tunnel syndrome caused by compressive lipoma in an athlete and the postoperative development of this syndrome.ResultsA 41-year-old ex-high-level female athlete complained of progressive paraesthesiae under the medial malleolus of her right foot, of five years’ duration. Clinical examination showed a mobile, painless mass in the same region. X-rays of the ankle revealed abnormalities in the soft tissue. Magnetic resonance imaging (MRI) showed swelling of the retromalleolar soft tissue. The diagnosis of lipoma was confirmed by histology. After surgery, the patient experienced partial improvement. Electromyography (EMG) was positive for posterior tibial nerve compression. MRI and ultrasound showed signs of postoperative fibrosis. After two infiltrations and medical treatment, moderate improvement was noted. The patient still describes some foot paraesthesiae nine months after surgery.ConclusionThe development of tarsal tunnel syndrome caused by compressive lipoma can be accelerated by a variety of factors, such as sporting activity. Both clinical examination and complementary investigations are useful in order to reach an accurate diagnosis. Failure of surgical decompression in our study points to fibrosis around the nerve or insufficient surgical excision.