Anterior Tarsal Tunnel Research Articles

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.

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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.