Anterior Tarsal Tunnel Syndrome Research Articles

Unravelling the Anatomy of the Anterior Tarsal Tunnel and Its Clinical Implications.

Anterior tarsal tunnel (ATT) syndrome is caused by the compression of the deep fibular nerve (DFN) within the ATT beneath the inferior extensor retinaculum, bounded by the tendons of the extensor hallucis longus (EHL) and extensor digitorum longus (EDL). Compression may result from direct trauma, repetitive mechanical irritation, and thrombosis of the dorsalis pedis artery. Injury to the contents of ATT could occur during ankle arthroscopy. Therefore,thisstudy was undertaken to provide a detailed description of the anatomy of the ATT and its clinical implications. Ten formalin-fixed cadavers were utilized for the study. The ATT was identified between the tendons of the EHL and EDL. The length at the medial and lateral boundaries and the width at the proximal end, middle, and distal end of the ATT were measured using a digital Vernier calliper. The mean length of the medial border of the tunnel was 31.42±8.44 mm, while the lateral border was 20.39±4.39 mm. The width of the ATT increased from the proximal to the distal end. DFN was related to the DPA laterally in 15 limbs and medially in five limbs within the tunnel. The present study not only describes the intricate anatomy of the ATT but also describes the patterns of DFN and DPA within the tunnel. Understanding the anatomy of ATT is crucial, as it paves the way for safe and efficient surgical interventions, thereby significantly reducing the risk of neurovascular damage during surgical procedures.

A Variant Dorsalis Pedis Artery and Its Relationship with the Deep Fibular Nerve

During a cadaveric dissection session, a distinctive neurovascular pattern was identified in the left leg of a 66-year-old female cadaver. The Anterior Tibial Artery (ATA), while maintaining a normal origin and luminal diameter, exhibited a shortened course, terminating in the upper third of the leg. In the lower third of the leg, the Fibular Artery (FA), known as the peroneal artery, traversed through the interosseous membrane to the anterior compartment, persisting as the Dorsalis Pedis Artery (DPA). The Deep Fibular Nerve (DFN), displaying a usual course in the upper two-thirds of the leg, crossed the variant DPA posteriorly and divided into two terminal branches on its posterolateral side. The medial terminal branch proceeded to cross the artery anteriorly within the anterior tarsal tunnel. This distinctive relationship between the DFN and the variant DPA renders the nerve susceptible to compression and may result in “anterior tarsal tunnel syndrome”.

Anterior Tarsal Tunnel Syndrome: Entrapment of the Articular Branch of Deep Peroneal Nerve

Case: A 28-year-old male patient who injured his ankle 2 years ago presented with unilateral ankle pain, tingling, and numbness for 1 year. Clinically, tenderness and positive Tinel sign were localized on anterior aspect of ankle. On exploration, deep peroneal nerve and mainly its articular branch were encased in fibrotic tissue. Decompression of both nerves resulted in symptomatic relief after surgery. Conclusion: High index of suspicion, a thorough medical history, meticulous clinical examination, complete knowledge of nerve anatomy, proper radiological studies, and careful surgical decompression are all necessary for the diagnosis and management of such atypical cases.

High Prevalence of Asymptomatic Anterior Tarsal Tunnel Syndrome in Toddy Tappers of South India: A Case Series of 21 Participants.

Background Anterior tarsal tunnel syndrome (ATTS) is an uncommon entrapment neuropathy which occurs due to the compression of deep peroneal nerve under the inferior extensor retinaculum at the ankle. We observed a frequent occurrence of this syndrome in toddy palm tappers and hence, planned to study the association between the two. Materials and Methods We studied the prevalence of isolated deep peroneal neuropathy at the ankle among the asymptomatic toddy tappers enrolled over a period of 3 months. Results In our case series, 81% (17/21) of the study participants had ATTS of which 43% (9/21) had unilateral and 38% (8/21) had bilateral involvement. There was a strong inverse association (p < 0.001) of “duration of toddy tapping in years” with peroneal (extensor digitorum brevis) amplitudes on both the sides. Conclusion Our study confirms “palm tree climbing” to be an occupational etiology of ATTS.

Mid-foot retinaculum: an unrecognized entity.

Retinacula are thickenings of deep fascia in the region of joints that hold down the tendons preventing them from bowing out of position. In the region of ankle, number of such retinacula have been described. Retinacula like superior and inferior extensor retinacula have been described which hold down the tendons of leg muscles passing to the foot beneath them. As the extensor tendons of the leg have more distal attachment to the toes, the present study was conducted to ascertain the presence of any additional retinaculum in the mid-foot region, which would tie down the tendons for their effective action at the distal joints. The aim was also to determine the attachments of the retinaculum, if present as well as the structures passing beneath them. Fifty cadaveric feet were dissected carefully for this purpose. Presence of an additional extensor retinaculum distal to the inferior band of inferior extensor retinaculum in the mid-foot region was found in 22 feet. Besides the extensor tendons, medial terminal branch of deep peroneal nerve and dorsalis pedis artery was found to pass beneath the retinaculum. A partial or complete mid-foot retinaculum existed in the mid-foot region covering the tarsometatarsal joints in about half of study population. Functionally, this retinaculum may prevent bowstringing of the extensor tendons, clinically it may predispose to entrapment of deep peroneal nerve mimicking anterior tarsal tunnel syndrome.

Unusual Cause of Anterior Tarsal Tunnel Syndrome: Ultrasound Findings

Journal of Ultrasound in MedicineVolume 36, Issue 4 p. 837-839 Clinical Letter Unusual Cause of Anterior Tarsal Tunnel Syndrome: Ultrasound Findings Tarvo Sillat MD, Corresponding Author Tarvo Sillat MD [email protected] Department of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria Radiology Department, North Estonia Medical Centre, Tallinn, EstoniaAddress correspondence to Tarvo Sillat, MD, Radiology Department, North Estonia Medical Centre, Sütiste 19, Tallinn, 13419, Estonia. E-mail: [email protected]Search for more papers by this authorChristopher Pivec MD, Christopher Pivec MD Department of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, AustriaSearch for more papers by this authorMaria Bernathova MD, Maria Bernathova MD Department of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, AustriaSearch for more papers by this authorThomas Moritz MD, Thomas Moritz MD Institute for Pediatric and Gynecologic Radiology, Kepler University Hospital, Linz, AustriaSearch for more papers by this authorGerd Bodner PhD, Gerd Bodner PhD Department of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria Private Ultrasound Center Vienna, Vienna, AustriaSearch for more papers by this author Tarvo Sillat MD, Corresponding Author Tarvo Sillat MD [email protected] Department of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria Radiology Department, North Estonia Medical Centre, Tallinn, EstoniaAddress correspondence to Tarvo Sillat, MD, Radiology Department, North Estonia Medical Centre, Sütiste 19, Tallinn, 13419, Estonia. E-mail: [email protected]Search for more papers by this authorChristopher Pivec MD, Christopher Pivec MD Department of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, AustriaSearch for more papers by this authorMaria Bernathova MD, Maria Bernathova MD Department of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, AustriaSearch for more papers by this authorThomas Moritz MD, Thomas Moritz MD Institute for Pediatric and Gynecologic Radiology, Kepler University Hospital, Linz, AustriaSearch for more papers by this authorGerd Bodner PhD, Gerd Bodner PhD Department of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria Private Ultrasound Center Vienna, Vienna, AustriaSearch for more papers by this author First published: 31 December 2016 https://doi.org/10.7863/ultra.16.03092Citations: 6Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume36, Issue4April 2017Pages 837-839 RelatedInformation

Anterior Tarsal Tünel Sendromu

Anterior tarsal tunnel syndrome (ATTS) occurs by the compression on the deep branch of the peroneal nerve. Although the compressions of posterior tibial nerve are diagnosed easily, ATTS may be difficult to realize. A 32-year-old male patient with numbness at first and second fingers of right foot was admitted to outpatient clinic. The right extensor digitorum brevis (EDB) muscle was atrophic electrophysiologically, compound muscle action potential (CMAP) of the peroneal nerve couldn't be obtained by recording at the right EDB muscle. Conduction speed and amplitude of right peroneal nerve recorded at tibialis anterior (TA) muscle were normal as well as the other nerve conductions of right and left lower extremities. The entrapment of the deep branch of peroneal nerve has been defined. We aimed to draw attention to this rare entrapment neuropathy by sharing a patient with weakness of foot and numbness in the first and second fingers of the foot.

Clinical and electrophysiological study of peripheral and central neuromuscular changes in connective tissue diseases in children

IntroductionChildren with juvenile connective tissue diseases (JCTDs) may have a wide variety of clinical features ranging from fever or a simple arthritis to complex multisystem autoimmune diseases. Aim of the workTo study clinical and electrophysiological peripheral and central neuromuscular changes in children with connective tissue diseases. Patients and methodsThirty children with different JCTDs were enrolled. Clinical and neurological examination and laboratory investigations were done. Electrophysiological evaluation was performed and included: peripheral nerve conduction studies, late responses, somatosensory evoked potential and electromyography. ResultsTwenty patients had juvenile idiopathic arthritis (JIA) (66.7%), 8 patients had juvenile systemic lupus erythematosus (JSLE) (26.7%), one patient had juvenile systemic sclerosis (JSScl), and one patient had juvenile overlap syndrome (JSScl and polymyositis). Clinical neurologic abnormalities were present in 3 patients (ulnar neuropathy, median neuropathy and polymyositis). Electrophysiological abnormalities were detected in 18 patients (clinical in 3 and subclinical in 15 patients) and included ulnar entrapment neuropathy, median axonal neuropathy, demyelinating sensory motor polyneuropathy, deep peroneal nerve entrapment at the ankle (anterior tarsal tunnel syndrome), prolonged posterior tibial somatosensory evoked potential latency and prolonged H reflex latency not explained by peripheral neuropathy, increased H/M ratio and myopathic motor units. The most common electrophysiological abnormalities were present in patients with JSLE. ConclusionClinical neurological abnormalities are not common in JCTDs whereas subclinical neurological abnormalities are common findings. Juvenile systemic lupus erythematosus had the most common abnormalities among JCTDs. Polyneuropathy in JIA is commonly of demyelinating type. Entrapment neuropathy is less frequent than in adults.

Treatment of anterior tarsal tunnel syndrome through an endoscopic or open technique

Anterior tarsal tunnel syndrome is often underdiagnosed, due to lack of clinical awareness and vague clinical presentation. Most often patients complain of pain located to the dorsum of the foot. The present study is a consecutive series of 13 patients treated according to a fixed protocol followed for a minimum of 24 months. A total of 12/13 cases presented with a bulge in the anterior part of the ankle or the dorsal foot and Tinel's sign was positive over it. Only half had decreased sensation. Surgical technique was either endoscopic or open. Endoscopy is preferable when compression is due to an osteophyte (4/13) or an isolated ganglion 2/13). In other cases presenting with synovitis (5/13) or unknown etiology (2/13) performing open surgery was deemed as safer.The American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scores improved from an average of 55±8 to 83±11 at 12 months after surgery and 88±10 at 24 months after surgery.The anterior tarsal tunnel syndrome accounts for approximately 5% of cases complaining of feet numbness, which undergo electromyographic and nerve conduction testing. Reports in the scientific literature are scarce, perhaps due to underdiagnosis, while it is amenable to surgical management. Clinical diagnosis supported by imaging studies demonstrated osteophytes, ganglions or localized synovitis. Endoscopic treatment can be performed safely provided a clear-cut single compressing element is identified.

Anterior tarsal tunnel syndrome: a misunderstood and a misleading entrapment neuropathy

Anterior tarsal tunnel syndrome (ATTS) is a rare entrapment neuropathy of the deep peroneal nerve beneath the extensor retinaculum on the top of the ankle. ATTS is often asymptomatic or olygosymptomatic. There are few reports describing the ATTS. We describe the clinical and electrophysiological features of 85 patients with unilateral or bilateral ATTS prospectively collected between January 2000 and December 2010 in our laboratory of Clinical Neurophysiology. This entrapment neuropathy remains poorly diagnosed and it might be misleading when performing a diagnostic EMG-ENG examination for suspected polyneuropathy or lumbosacral radiculopathy.

Anterior tarsal tunnel syndrome secondary to missed talus fracture: a case report

The anterior tarsal tunnel syndrome (ATTS) has first been described by Kopell and Thompson in 1963. The anterior tarsal tunnel is formed by the fascia lining the inferior extensor retinaculum and talus as well as the navicular bone. Many ATTS cases with various etiologies have been reported since the first description. We report here an ATSS case resulting from a fibro-osseous structure that occurred after a missed talus fracture. The ATTS diagnosis can be made with a comprehensive clinical neurological examination and electrophysiological study. The treatment is based on the underlying etiology, while surgery is the most common treatment providing successful outcomes in the long term.

Dimensions of the anterior tarsal tunnel and features of the deep peroneal nerve in relation to clinical application

The aim of this study was to demonstrate anatomical features of the anterior tarsal tunnel and the deep peroneal nerve and to discuss the importance of these structures for the anterior tarsal tunnel syndrome and some other surgical approaches to minimize the injury risk. Lower limbs of 18 formalin fixed cadavers were examined. The limbs showed no evidence of pathology or trauma. The lateral length of the tunnel was 21.7 +/- 4.3 mm and the medial length of the tunnel was 55.0 +/- 9.0 mm. The width of the tunnel at the inferior border between the extensor hallucis longus and extensor digitorum longus tendons was 12.6 +/- 2.1 mm. The location of the deep peroneal nerve bifurcation was in the anterior tarsal tunnel in 31 specimens (86.1%) and distal to the tunnel in two specimens (5.6%). In three specimens (8.3%) there was no bifurcation because of the absence of the medial terminal branch of the deep peroneal nerve. In these three specimens, the superficial peroneal nerve distributed to the adjacent sides of the great and second toes. Bifurcation above the tunnel was not observed in our specimens. There was connection between the deep peroneal nerve and the superficial peroneal nerve in 10 specimens (27.8%) in the first interdigital space. During the observations, the presence of a fibrous band over the nerve and vessel was noted in 22 specimens (61.1%). We believe that a detailed anatomic knowledge of the anterior tarsal tunnel and the deep peroneal nerve will be of help during surgical approaches to this area and the diagnosis of the problems related to the peripheral nerves on the dorsum of the foot.

0377 Anterior tarsal tunnel's syndrome, presentation of five cases

0377 Anterior tarsal tunnel's syndrome, presentation of five cases

Correspondence: Anterior tarsal tunnel syndrome in the post partum period

Correspondence: Anterior tarsal tunnel syndrome in the post partum period

Ankle impingement syndromes

The ankle impingement syndrome is a frequent condition in both athletes and the normal population. We investigated this painful syndrome from both a clinical and a diagnostic viewpoint. Depending on what ankle tissue impinges on the other, it is possible to distinguish bone impingement, soft tissue impingement and peripheral nerve entrapment. For each of these pathologic conditions we investigated the diagnostic role of conventional radiography, Computed Tomography and Magnetic Resonance Imaging. The evidence of osteophytes, exostosis and presence of the os trigonum on plain films make clinical diagnosis easy in both anterior and posterior bone impingement. CT can provide useful information about the component of the posterior ankle. MRI always adds important information about chondral or subchondral bone injuries, synovial reaction and adjacent soft tissue involvement. The anterolateral impingement syndrome is caused by repeated injuries in plantar flexion and ankle intrarotation. MRI well detects the meniscoid injury thanks to high contrast sequences; it can also distinguish this syndrome from painful chondral and/or bony lesions at this level. MRI is also the method of choice to study sinus tarsi impingement, especially thanks to fat suppression sequences which increase MR diagnostic capabilities in this important anatomic area. Deep peroneal nerve entrapment, the medial plantar nerve entrapment syndrome and the tarsal tunnel syndrome are the most important entrapment neuropathies of the ankle. US and MRI are very useful to study the tendon and soft tissue abnormalities causing the anterior tarsal tunnel syndrome. CT and particularly MRI can easily detect many pathologic conditions causing the medial plantar nerve entrapment and the tarsal tunnel syndromes.

前足根管症候群の手術例について

The anterior tarsal tunnel syndrome is an entrapment neuropathy of the deep branch of the peroneal nerve beneath the inferior extensor retinaculum.The authors surgically treated seven cases of anterior tarsal tunnel syndrome. Two male and four female patients ranged in age from 10 to 80 years.After failure of conservative therapy (steroid in filtrated into trigger point, vitamin B1 and B12 medication the patients underwent surgery.The patients complained of pain or paresthesia in the dorsum of the foot and the first interdigital space.At exploration, the causes of compression were as follows: cicatricial, thickened membranous tissue over the head of the tales in four cases, anterior protrusion of the anterior edge of the distal tibia in two, tendon of the extensor hallacis muscle in two, adhesion and scar tissue in one.In all cases sensory recovery occurred with in a few days after the surgical decompression.The authors believe that sitting in the Japanese style is one of the causes of extrusion.

Entrapment neuropathy of the deep peroneal nerve associated with the extensor hallucis brevis

The authors report a case of entrapment neuropathy of the deep peroneal nerve associated with the extensor hallucis brevis. This entrapment neuropathy was found distal to the inferior retinaculum that causes the anterior tarsal tunnel syndrome. Surgical decompression of the deep peroneal nerve that was entrapped by the extensor hallucis brevis relieved the symptoms. This condition, like the anterior tarsal tunnel syndrome, deserves attention.

Anterior tarsal tunnel syndrome

Anterior tarsal tunnel syndrome

Anterior Tarsal Tunnel Syndrome

The anterior tarsal tunnel syndrome, described by Marinacci in 1968, is an entrapment neuropathy of the deep branch of the peroneal nerve beneath the inferior extensor retinaculum. Five cases of this syndrome are presented. The patients have complained pain or paresthesia in front of the ankle or dorsum of the foot. Hypaesthesia and hypoalgesia were found in sensory area of the deep peroneal nerve which was distinctly sensitive to pressure under the inferior extensor retinaculum. It is necessary to take care in making examinations on a patient who shows symptoms on the same place so as to avoid misdiagnosis and useless diagnostic procedures and treatment.

The anterior tarsal tunnel syndrome.

The anterior tarsal tunnel syndrome, first described in 1968 by Marinacci, is characterized by a compression of the deep peroneal nerve under the inferior extensor retinaculum. The patients complaint of pains on the dorsum of the foot, especially at night. Clinically result sensory deficits in the involved area between the first and second toes as well as paresis and atrophy of the extensor digitorum brevis. The distal latency of the deep peroneal nerve is increased, the EMG shows active and chronic denervation of the extensor digitorum brevis. In cases with partial anterior tarsal tunnel syndrome only the motoric branch to the extensor digitorum brevis or only the sensory branch of the deep peroneal nerve after the division under the inferior extensor retinaculum is compressed. Two cases with complete and one with partial anterior tarsal tunnel syndrome are presented, etiology, symptomatology, differential diagnosis and therapeutic possibilities are discussed.