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  6. Tarsal Tunnel

Tarsal TunnelClinical case and images provided by Avneesh Chhabra, M.D., Johns Hopkins University School of Medicine, Baltimore, USA

Clinical question

41-year-old woman with heel pain.

  • Prior tarsal tunnel release many month ago

 

Tarsal Tunnel
High trifurcation of TN - MPN (red), LPN (blue) and calcaneal nerve (yellow)

Clinical images

Focally enlarged MPN
Focally enlarged MPN
MPN - Bright with focal enlargement
MPN - Bright with focal enlargement
Tarsal Tunnel
LPN- diffusely enlarged and bright below Abd hallucis
Tarsal Tunnel
Thin MIP 3D WE PSIF

Interpretation

  • Accessory muscle missed on prior surgery, seen on MRN
  • Visualization of high trifurcation and abnormality of all three nerves (MPN, LPN and enlarged nerve) helped the surgeon
  • Clarification of calcaneal nerve and plantar nerves to help the surgeon
  • Diagnosis - Nerve re-entrapment and prior inadequate tarsal tunnel release

 

Consequences for treatment

  • Surgery performed again to resect the calcaneal nerve
  • Consequently improvement in symptoms