Muscular Abnormalities due to Tarsal Tunnel Syndrome: An Inf
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A clinical case of a female patient affected by bilateral tarsal tunnel syndrome is described. The patient reported an onset of moderate dysesthetic symptoms in the plantar side of the right foot at the age of 31. She then developed similar symptomatology in the left foot after 4 months. Throughout the following 3 months, the painful symptoms increased, even at rest.

The peculiarity of this case is the difference in the observed anatomopathological muscular abnormalities between the two feet. On one side, an accessory muscular venter of the toes long flexor was identified. On the other side, posterior tibial nerve compression was determined by an accessory venter of the hallux long flexor, associated with an abnormal venter of the toes long flexor, with a minor extent if compared to contralateral findings.

At observation, both feet did not show any morphological disorder. Tinel’s sign was clearly positive bilaterally and a subtalar stiffness was present. It was then decided to carry out surgery. A standard access (retro- and submalleolar posterior convexity incision) to the left foot was performed and showed an accessory venter of the toes common flexor that invaded the nerve for the length of 15 mm and the nerve had a one-third smaller diameter. The accessory venter was then removed and neurolysis was performed till the nerve’s bifurcation. An immediate postoperative improvement of the plantar dysesthesia was achieved. The patient was discharged after few days wearing a plaster brace, and loading was then allowed 4 weeks after surgery.

Eventually, another surgery was carried out also in the right foot and intraoperative findings confirmed the presence of an accessory venter in the toes common flexor but smaller and less widespread if compared with contralateral findings. An abnormal venter of the hallux’s long flexor reaching beyond the apex of the medial malleolus. The posterior tibial nerve was compressed between the two muscular venters but showed no macroscopic disorder. A part sized 1 × 2 × 4 cm of the abnormal venter was then removed.

In the case of a symptomatic patient with a clinical onset of tarsal tunnel syndrome, in the presence of negative diagnostic and radiological examinations, it is adviced to always suspect the onset of anatomical abnormalities.