Tarsal tunnel syndrome

We start with a differential of burning feet (the Burning Feet Syndrome – in my view a somewhat aloof entity about as specific as headache) and come to the neurological possibilities of aquiring foot pain, then on to the symptoms of tarsal tunnel syndrome and why it is definitely completely unalike the carpal tunnel syndrome:

  • rare in the Neurologist’s hand (foot?), but a very prevalent working diagnosis both of podiatrists and orthopedists
  • hard to identify clinically
  • probably not caused (albeit possibly triggered) by exercise / marathon running / high heels
  • often misdiagnosed in PNP, radicular syndromes
  • electrophysiologically even more elusive than CTS
  • definitely not as treatable.

My favorite diagnostics is lidocaine injection, although I do ephys to rule out PNP and S1, if not clinically evident. My experience with the various ways to investigate the tarsal tunnel itself is limited and anyone has a different favorite, but I’d forgo EMG, do motor NCS over the tibial nerve to the medial and lateral plantar nerve as well as antidromic sensory NCS, possibly below and above the tunnel, always comparing left to right.

As for reference, I recommend my favorite book on electrophysiology, namely Preston/Shapiro – electromyography and neuromuscular disorders. In our house, the Mumenthaler/Stöhr is (of course) a similarly helpful source.


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