Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic medial ankle and plantar foot pain, described as burning, tingling, and paresthesia. Symptoms are exacerbated by prolonged standing, walking, and activity, with nocturnal exacerbation noted. Patient denies acute trauma. Symptoms follow the distribution of the tibial nerve.
Clinical Examination Findings
Physical examination reveals positive Tinelβs sign over the tarsal tunnel. Tenderness to palpation noted along the course of the posterior tibial nerve. Sensory deficit noted in the plantar aspect of the foot. Motor strength is intact, though intrinsic muscle atrophy may be present in chronic cases. Dorsiflexion-eversion test is positive, reproducing symptoms.
Treatment Protocol
Conservative management initiated: activity modification, orthotic inserts to correct foot mechanics, and non-steroidal anti-inflammatory drugs (NSAIDs). Physical therapy focusing on nerve gliding exercises and strengthening. Consider corticosteroid injection for localized inflammation. If refractory, surgical consultation for tarsal tunnel release is indicated.