What's involved:

Posterior Tibial Nerve

Location:

Posterior Tibial nerve entrapment at the Tarsal Tunnel in the foot at the level of the medial malleolous

Common symptoms:

	Foot, Ankle, Sole pain/burning and aching
	Worse at night
	Occasional numbness/tingling sole of foot
	No muscle weakness
	Usually unilateral
	Difficulty walking because of pain and discomfort with shoes
	Positive Tinel (tingling upon tapping nerve) sign behind the medial malleolous

Risk factors:

	No gender preference
	Diabetes or family history of Diabetes, Alcoholism or other occupational or nutritional causes of Neuropathies, HIV infection
	Usually post-traumatic
	Can be aggravated with joint inflammation from tenosynovitis, phlebitis

Exam:

	Very positive and tender Tinel (tingling upon tapping nerve) sign behind the medial malleolous
	Usually ankle swelling, tenderness
	No weakness or atrophy
	May have decreased sensation over the sole of the foot
	Patient quite uncomfortable with standing, walking

Localization:

The Posterior Tibial nerve inside the Tarsal Tunnel affecting both Medial and Lateral Plantar nerves of the foot

EMG:

	Prolonged Posterior Tibial distal latency to the Abductor Hallucis or Abductor Digiti Quinti Pedis
	May be accompanied by low motor amplitude or absent responses in either of these muscles
	Medial and/or Lateral plantar sensory action potentials may be affected early on with prolonged latency, slowed velocity and decreased amplitude
	Sensory Action potentials unobtainable in advanced cases
	Needle exam of Abductor Hallucis and/or Abductor Digiti Quinti Pedis may show denervation, active and/or chronic
	Check non-Posterior Tibial muscles (Extensor Digitorum Brevis) or Posterior Tibial muscles above the Tarsal Tunnel (Posterior Tibialis) are spared and Lumbo-Sacral paraspinals are intact to ensure this is not an S1 root lesion

Recommendations:

	Symptomatic treatment by relieving cause and treating local trauma
	Foot brace and arch support
	Antiinflammatories medications
	Surgery in advanced cases
	In complicated and post-operative ankle injuries, surgery may actually worsen the symptoms

What else could it be: