Intraneural Ganglia as cause of Tarsal Tunnel Syndrome

NewsBot · Jan 3, 2007

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Tibial Intraneural Ganglia in the Tarsal Tunnel: Is There a Joint Connection?
J Foot Ankle Surg. 2007 January - February;46(1):27-31
Spinner RJ, Dellon AL, Rosson GD, Anderson SR, Amrami KK

Intraneural ganglia are rare entities, and, as such, their pathogenesis has been extremely controversial. Recent evidence from intraneural ganglia occurring at more proximal sites-the peroneal nerve at the fibular neck (the most common site) and the tibial nerve at the knee-has suggested an articular origin rather than de novo formation. To our knowledge, of the 10 previous reports of tibial intraneural ganglia within the tarsal tunnel by others, a joint connection to the ankle joint was only identified in 2 cases. To support a hypothesis that tibial intraneural ganglia occurring within the tarsal tunnel region arise from neighboring joints, we analyzed 3 patients retrospectively, all of whom had magnetic resonance (MR) imaging and operative intervention. One of these patients was treated by a peripheral nerve surgeon specializing in foot and ankle surgery. The other 2 patients were the only ones previously published in the literature who had MR images available for reinterpretation. In none of these cases was a joint communication appreciated by radiologists interpreting the MR images preoperatively or by surgeons intraoperatively. Our review of these same cases demonstrated radiographic evidence of joint communications with the subtalar joints. Based on our findings in this article and our knowledge of intraneural ganglia occurring at more proximal sites, we believe that tibial intraneural ganglia within the tarsal tunnel originate from neighboring joints and that their connections to the joints (pedicles) are through articular branches. The importance of these connections is 2-fold: first, for their role in the pathogenesis of this entity, and second, for their potential therapeutic implications. As is highlighted by the clinical and radiographic follow-up in the 1 patient in this article and in many previously reported at other sites, intraneural cyst recurrence can occur if surgeons do not specifically address the articular connection.
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NewsBot · Jan 4, 2007

Tarsal tunnel syndrome caused by a talocalcaneal joint amyloidoma in a long-term haemodialysis patient: a case report.
J Orthop Surg (Hong Kong). 2006 Dec;14(3):350-3Sekiya H, Arai Y, Sugimoto N, Sasanuma H, Hoshino Y

We present a case of tarsal tunnel syndrome caused by an amyloidoma arising from the talocalcaneal joint in a 64-year-old man with a long history of haemodialysis. He presented with numbness in the medial plantar area of the right foot without any antecedent trauma. The numbness was minimal at rest but gradually worsened, causing difficulty, when walking. Paraesthesia was present on the medial sole of the right foot. A positive Tinel-like sign was noted 2.5 cm below the medial malleolus. Magnetic resonance imaging demonstrated a round lesion, 1 cm in diameter, in the calcaneus, which was hypointense on T1-weighted images and hyperintense on T2-weighted images. In addition, a mass, 1 cm in diameter with a signal isointense to that of muscle was found adjacent to the talocalcaneal joint. The medial plantar nerve was decompressed after removing a solid, 1-cm diameter mass from the talocalcaneal joint. At 6 months post surgery, the numbness had completely resolved. No recurrence was observed at the 24-month follow-up.
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Admin2 · Jan 6, 2007

Related threads:
Strain in tibial nerve
Tarsal tunnel volume and foot position
Tarsal Tunnel Syndrome

NewsBot · Dec 1, 2007

Tarsal Tunnel Syndrome in a Patient on Long-Term Peritoneal Dialysis: Case Report.Ozdemır O, Calişaneller T, Sönmez E, Altinörs N.
Turk Neurosurg. 2007;17(4):283-285.

Tarsal tunnel syndrome (TTS) is defined as the entrapment of the posterior tibial nerve in the tarsal tunnel of the ankle. The etiologies of tarsal tunnel syndrome are mainly the presence of a ganglion, osseous prominence with tarsal bone coalition, trauma, varicose veins, neurinoma, hypertrophy of the flexor retinaculum, or systemic disease (rheumatoid arthritis, ankylosing spondylitis). However, no specific cause can be identified in some cases. Patients with chronic renal failure tend to develop peripheral nerve entrapment and carpal tunnel syndrome is the best-known peripheral entrapment neuropathy among them. Contrary to carpal tunnel syndrome, tarsal tunnel syndrome is observed less frequently in chronic renal failure patients. The common presenting symptoms of TTS are paresthesias and/or pain in the plantar side of the foot. Motor symptoms are rarely detected. Diagnosis is made primarily by electroneuromyographic studies and physical examination. Surgery is the treatment of choice and the outcome is generally favourable. In this report, we present a patient with tarsal tunnel syndrome complicating peritoneal dialysis.
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NewsBot · Mar 5, 2014

A rare case of an accessory flexor hallucis longus causing tarsal tunnel syndrome
D. Lina, C. Williams, H. zaw
Foot and Ankle Surgery; Available online 5 March 2014

Tarsal Tunnel Syndrome (TTS) is a rare entrapment neuropathy of the tibial nerve within the fibro-osseous tarsal tunnel for which multiple etiologies, including trauma, congenital foot abnormalities and space occupying lesions, have been described. We present an unusual case of TTS caused by an accessory Flexor Hallucis Longus (FHL) tendon. Surgical excision led to a complete resolution of symptoms and improved the quality of life of our patient.
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NewsBot · Jan 8, 2017

Tarsal Tunnel Syndrome Due To Three Different Types of Ganglion During a 12-Year Period: A Case Report
Motohisa Kawakatsu et al
Journal of Foot and Ankle Surgery Article in Press

A 52-year-old male complained of numbness and radiating pain affecting the plantar region of his left foot. He was found to have recurrent tarsal tunnel syndrome due to posterior tibial nerve compression by 3 different types of ganglion during a 12-year period. To the best of our knowledge, a similar case has not been documented. At the first operation, flexor retinaculum release and simple excision of an epineural ganglion were performed without injuring the nerve fascicles; however, an intrafascicular ganglion developed approximately 2 years later. At the second operation, the ganglion cyst was resected completely to prevent recurrence, despite the risk of nerve fiber injury. The cyst originated from the subtalar joint; thus, the joint was closed, and a free fat graft was placed to prevent adhesion formation. However, an extraneural ganglion occurred about 3 years later. At the third operation, the cyst was resected completely, and a free periosteal graft was used to close the joint more effectively. No recurrence had developed at 6 years after the third operation. The findings of the present case show the need for long-term monitoring of patients with tarsal tunnel syndrome caused by a ganglion owing to the possibility of recurrence related to different ganglion types.
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NewsBot · Apr 30, 2017

Venous malformation as source of a tarsal tunnel syndrome: treat the source or the cause of the complaints? A case report.
Mufty H et al
Acta Chir Belg. 2017 Apr 28:1-4. doi: 10.1080/00015458.2017.1321268

Painful tarsal tunnel syndrome is a compression neuropathy with a variety of possible sources. As it presents a challenging differential diagnostic problem, it is often under-diagnosed. Among the intrinsic and extrinsic factors, varicose veins are the main source in case of a venous etiology. We report a case of a 39-year old male patient who presented with complaints of paresthesia and excessive pain of the right foot, especially the medial side. Further work up by ultrasonography, magnetic resonance imaging and electromyography revealed an extensive congenital venous malformation of the right lower limb with subsequent compression of the tibial nerve in the tarsal tunnel. We did not treat the source, but the cause by open tarsal tunnel release. Excellent result with immediate full relieve of the patients complaints was achieved.
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NewsBot · Mar 28, 2022

Accessory Flexor Digitorum Longus Presenting as Tarsal Tunnel Syndrome: A Case Series
Parkhurst, Drew B et al
Clinical Journal of Sport Medicine: March 21, 2022 - Volume - Issue - 10.1097/JSM.0000000000001025

Tarsal tunnel syndrome (TTS) typically occurs from extrinsic or intrinsic sources of compression on the tibial nerve. We present 3 cases of patients, all of whom have a prolonged time to diagnosis after evaluation with multiple specialties, with foot pain ultimately secondary to an accessory flexor digitorum longus muscle causing TTS. The literature describing the association between TTS and accessory musculature has been limited to single case reports and frequently demonstrate abnormal electrodi
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NewsBot · Mar 31, 2022

Tarsal tunnel syndrome secondary to accessory or variant muscles: a clinical and anatomical systematic review
Kaissar Yammine et al
Surg Radiol Anat. 2022 Mar 30

Purpose: Many etiologies are known to lead to a tarsal tunnel syndrome (TTS). One rare cause is mass-occupying lesions, and particularly accessory or variant muscles (AVM). This study aimed to systematically collect published clinical cases of TTS caused by AVM.

Methods: An electronic literature search was conducted from inception to April 2021. The diagnosis of AVM should be reported in one of the following methods: ultrasonography, magnetic resonance imaging (MRI), or per-operatively. Data extraction included types and prevalence of accessory muscles, clinical presentation and diagnosis, and treatment modalities. Twenty-five studies were identified with a total 39 patients (47 ankles).

Results: The prevalence of TTS was reported in only two studies (9%). Forty-nine AVM were identified with the accessory flexor digitorum longus being the most common (52%). The most common sign/symptoms were tenderness (78.7%), pain (82.9%), dysesthesia (57.4%), Tinel sign (44.6%), and a swelling (25.5%). Decompression and excision were the most commonly performed procedures. Four accessory/variant muscles in the ankle have the potential to induce a tarsal tunnel syndrome.

Conclusion: This review highlights the clinical and imagery specificities of TTS secondary to accessory or variant muscles. Mass-occupying etiology should be included in the list of differential diagnoses whenever a posterior tibial nerve compression is suspected.
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NewsBot · Apr 5, 2022

A Rare Case of Flexor Digitorum Accessorius Longus Muscle Presenting as Tarsal Tunnel Syndrome
Hossein Ettehadi et al
Arch Bone Jt Surg. 2022 Jan;10(1):112-116

Tarsal tunnel syndrome (TTS) is a relatively uncommon nerve entrapment neuropathy. Many pathologies are reported as possible causes for TTS. The diagnosis of TTS can be difficult and often missed. We present a rare case of TTS due to an accessory flexor digitorum longus muscle. Together with a high index of suspicion, MRI is the investigation of choice in making the diagnosis. These patients are best managed with excision or transposition of the flexor digitorum accessorius longus (FDAL) and neurolysis of the posterior tibial nerve and its branches.
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