Tarsal Tunnel Syndrome - Question

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Hi All,

I believe I have been noticing a common theme with my patients that present with tarsal tunnel syndrome (as diagnosed by +ve tinels sign and pt c/o paraesthesia, shooting pains etc). It seems to be more prevalent in pts that have a very high velocity of pronation (and often only a very small degree) rather than those with an excessive amount of pronation at a slower velocity.

I am not entirely sure I can provide a suitable rationale for this, except perhaps the speed at which the posterior tibial nerve is compressed could be linked to the formation of the pathology?

Also, this is completely subjective as I have absolutely no way of objectively measuring the velocity of pronation and I can't back this up with any evidence. I could well be talking "twaddle" but I just wanted to see if any one else had noticed any thing similar... or if it is indeed a common understanding..

Kind regards,

Sam Randall

 

Hi Sam,

I think its a fair assumption to make when considering the viscoelastic properties of tissue (load/deformation characteristics, strain rate sensitivity etc) that velocity of motion is a factor to consider. Like you say this is difficult to quantify clinically.

Ian

 

Sam:

I have not seen this "very high velocity pronation" in the patients that I have treated with tarsal tunnel syndrome. The patients I have seen with tarsal coalition are generally excessively pronated but I have not noticed that they pronate any faster than average. Most will respond to orthoses with medial heel skives and higher medial arch heights combined with shoes with higher heel height differential.