Tarsal tunnel

The tibial nerve, posterior tibial artery, posterior tibial vein, and flexor tendons travel in a bundle along this pathway through the tarsal tunnel, in the following order from antero-medial to postero-lateral:

• Tibialis posterior tendon
• Flexor digitorum longus tendon
• Posterior tibial artery
• Posterior tibial vein
• Tibial nerve
• Flexor hallucis longus tendon

In the tunnel, the nerve splits into three different paths. One nerve (calcaneal) continues to the heel, the other two (medial plantar nerve and lateral plantar nerve) continue on to the bottom of the foot.

Tarsal tunnel syndrome is the most commonly reported nerve entrapment of the ankle and is analogous to the carpal tunnel of the wrist. People with tarsal tunnel syndrome have pain in the plantar aspect of the foot mostly at night. Weight bearing increases pain and weakness is found on intrinsic foot muscles with positive Tinel sign at the tunnel. There is no tenderness present on the plantar foot, though this is typically the primary site of complaint.