Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, progressive pain, paresthesia, and burning sensations localized to the medial aspect of the left ankle and plantar surface of the foot. Symptoms are exacerbated by prolonged standing, walking, and physical activity, with nocturnal exacerbation noted. Patient denies recent trauma, but reports subjective numbness in the distribution of the medial and lateral plantar nerves.
Clinical Examination Findings
Left ankle examination reveals positive Tinelβs sign over the tarsal tunnel (posterior to the medial malleolus). Sensory testing demonstrates diminished light touch and pinprick sensation in the medial and lateral plantar nerve distributions. Motor strength is intact, though atrophy of the intrinsic foot musculature is noted in chronic cases. Passive dorsiflexion-eversion test of the left ankle reproduces symptoms.
Treatment Protocol
Conservative management initiated: activity modification, orthotic intervention with medial arch support, and non-steroidal anti-inflammatory drugs (NSAIDs). Consider physical therapy for nerve gliding exercises. If refractory, consider diagnostic/therapeutic corticosteroid injection into the tarsal tunnel or electrodiagnostic studies (EMG/NCS) to confirm nerve entrapment severity.