Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, progressive burning pain, paresthesia, and numbness localized to the medial aspect of the right ankle and plantar surface of the foot. Symptoms are exacerbated by prolonged standing, walking, and activity, with nocturnal exacerbation noted. No history of acute trauma. Patient reports subjective weakness and occasional "pins and needles" sensation in the distribution of the tibial nerve.
Clinical Examination Findings
Right ankle examination reveals positive Tinelβs sign over the tarsal tunnel (posterior to the medial malleolus). Sensory testing demonstrates diminished light touch and pinprick sensation along the medial and lateral plantar nerves. Motor strength is 4/5 in intrinsic foot musculature. No significant edema or erythema noted. Gait analysis shows antalgic pattern favoring the lateral border of the foot.
Treatment Protocol
Initiate conservative management including activity modification, orthotic intervention with medial arch support, and non-steroidal anti-inflammatory drugs (NSAIDs). Consider physical therapy focusing on nerve gliding exercises. If refractory, discuss corticosteroid injection into the tarsal tunnel or surgical consultation for tarsal tunnel release.