Tarsal tunnel
Encyclopedia
The tarsal tunnel is found along the inner leg behind the medial malleolus.
The tarsal tunnel is made up of bone on the inside and the flexor retinaculum on the outside.
, a major artery, veins, and tendons travel in a bundle along this pathway, through the tarsal tunnel.
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.
One common mnemonic used to remember the contents is "Tom, Dick and Harry
". or alternatively "Tom, Dick (and very nervous) Harry" if the artery, vein, and nerve are included.
Another common mnemonic used is "Tiny Dogs Are Not Hunters". Bear in mind that tibial veins are located on both sides of tibial artery.
All three muscles are part of the posterior compartment of leg
.
The tarsal tunnel is made up of bone on the inside and the flexor retinaculum on the outside.
Nerve distribution
The tibial nerveTibial nerve
The tibial nerve is a branch of the sciatic nerve. The tibial nerve passes through the popliteal fossa to pass below the arch of soleus.In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris muscles, an articular branch to the knee joint, and a...
, a major artery, veins, and tendons travel in a bundle along this pathway, through the tarsal tunnel.
In the tunnel, the nerve splits into three different paths. One nerve (calcaneal
Medial calcaneal branches of the tibial nerve
The medial calcaneal branches of the tibial nerve perforate the laciniate ligament, and supply the skin of the heel and medial side of the sole of the foot.-See also:* Cutaneous innervation of the lower limbs...
) continues to the heel, the other two (medial plantar nerve
Medial plantar nerve
The medial plantar nerve , the larger of the two terminal divisions of the tibial nerve, accompanies the medial plantar artery....
and lateral plantar nerve
Lateral plantar nerve
The lateral plantar nerve is a branch of the tibial nerve, in turn a branch of the sciatic nerve and supplies the skin of the fifth toe and lateral half of the fourth, as well as most of the deep muscles, its distribution being similar to that of the ulnar nerve in the hand.It passes obliquely...
) 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.
Contents of tunnel
- Tibialis posterior muscleTibialis posterior muscleThe Tibialis posterior is the most central of all the leg muscles, and is located in the posterior compartment of the leg.It is the key stabilizing muscle of the lower leg....
- Flexor digitorum longus muscleFlexor digitorum longus muscleThe Flexor digitorum longus is situated on the tibial side of the leg. At its origin it is thin and pointed, but it gradually increases in size as it descends...
- Posterior tibial arteryPosterior tibial arteryThe posterior tibial artery of the lower limb carries blood to the posterior compartment of the leg and plantar surface of the foot, from the popliteal artery...
- Posterior tibial veinPosterior tibial veinIn anatomy, the posterior tibial vein of the lower limb carries blood from the posterior compartment and plantar surface of the foot to the popliteal vein which it forms when it joins with the anterior tibial vein....
- Tibial nerveTibial nerveThe tibial nerve is a branch of the sciatic nerve. The tibial nerve passes through the popliteal fossa to pass below the arch of soleus.In the popliteal fossa the nerve gives off branches to gastrocnemius, popliteus, soleus and plantaris muscles, an articular branch to the knee joint, and a...
- Flexor hallucis longus muscleFlexor hallucis longus muscleThe Flexor hallucis longus muscle is a muscle of the leg.It is one of the deep muscles of the posterior compartment of the leg. The other deep muscles of the leg are flexor digitorum longus and tibialis posterior. Tibialis posterior is most powerful of these deep muscles.The Flexor hallucis...
One common mnemonic used to remember the contents is "Tom, Dick and Harry
Tom, Dick and Harry
The phrase "Tom, Dick and Harry" is a placeholder for multiple unspecified people; "Tom, Dick or Harry" plays the same role for one unspecified person. The phrase most commonly occurs as "every Tom, Dick and Harry", meaning everyone, and "any Tom, Dick or Harry", meaning anyone, although Brewer...
". or alternatively "Tom, Dick (and very nervous) Harry" if the artery, vein, and nerve are included.
Another common mnemonic used is "Tiny Dogs Are Not Hunters". Bear in mind that tibial veins are located on both sides of tibial artery.
All three muscles are part of the posterior compartment of leg
Posterior compartment of leg
The posterior compartment of the leg is supplied by the tibial nerve.It contains the plantar flexors:* deep: popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior* superficial/calf: gastrocnemius, soleus, plantaris...
.
External links
- Description at curtin.edu.au
- http://www.ithaca.edu/faculty/lahr/LE2000/ankle%20pics/5Asupmed.jpg