Recognizing Foot and Ankle Problems in Athletes
Some sports injuries are uncommon or even rare. Doctors need some ways to recognize these problems sooner. Tarsal tunnel syndrome (TTS) is one of these conditions. TTS is the compression of the tibial nerve as it travels through the bones of the ankle. It is often misdiagnosed or overlooked. Delay in diagnosis and treatment can cost an athlete the season.

In this study, surgeons at the Osaka Medical College in Japan looked back at the charts of patients who were treated for TTS. The idea was to look for any typical factors that would help doctors identify TTS sooner.

For example, they checked the medical charts to see how many patients diagnosed with TTS had a previous history of trauma to the foot and/or ankle. How severe was the injury? They looked for physical movements or sports activities that were linked with the patient's pain before the diagnosis was made. They recorded tests done and results for each one.

What they found was that all the patients had tenderness behind the medial malleolus (inner ankle bone). All had a positive Tinel's sign. This means when the skin is tapped over a nerve, the patient gets a slight shocking sensation.

Nerve testing showed decreased motor and sensory function. Most patients had symptoms during repetitive motions. Jumping, sprinting, and quick flexion of the ankle brought the symptoms on in all cases. The results of X-rays, CT scans, and MRIs were all reviewed to see what structures were abnormal around the ankle and foot.

In almost every case, the imaging studies showed the cause of the problem. Sometimes it was an extra muscle or extra bone putting pressure on the tibial nerve. Old or new bone fractures were found. Cysts, bulges in the normal bones, flatfeet, or partial bone fusions were other causes of TTS.

All patients' symptoms went away after surgery to release pressure on the tibial nerve. This was the final diagnostic test for TTS. The authors conclude that sports athletes with symptoms described who have a positive Tinel's sign should be further examined with X-rays or other more advanced imaging. Surgery may be needed to restore the tibial nerve and return the athlete to full participation in sports.
Mitsuo Kinoshita, MD, et al. Tarsal Tunnel Syndrome in Athletes. In The American Journal of Sports Medicine. August 2006. Vol. 34. No. 8. Pp. 1307-1312.