The Posterior Tibial Artery Compressing the Medial Plantar Nerve
Tarsal Tunnel Syndrome Secondary to Neurovascular Conflict
DOI:
https://doi.org/10.59667/sjoranm.v28i1.36Keywords:
Tarsal tunnel syndrome, Posterior tibial artery, Medial plantar nerve, Neurovascular compression, UltrasoundAbstract
Introduction: Tarsal tunnel syndrome (TTS) is a compressive neuropathy involving the posterior tibial nerve or its branches within the fibro-osseous tarsal tunnel. Vascular etiologies are underrecognized and may be overlooked in clinical assessment.
Objective: To illustrate the diagnostic value of dynamic ultrasound in identifying clinically significant neurovascular compression in TTS.
Case report: A 32-year-old woman presented with right ankle pain associated with intermittent electric shock–like sensations over the medial plantar aspect of the foot, exacerbated by prolonged walking. Physical examination revealed a positive Tinel sign along the medial plantar nerve. Ultrasound demonstrated close contact between the posterior tibial artery and the medial plantar nerve without other structural abnormalities, suggesting neurovascular compression.
Conclusion: Vascular causes of TTS should be considered in patients presenting with plantar neuropathic symptoms. High-resolution ultrasound with color Doppler plays a key role in identifying neurovascular conflict and guiding clinical management.
References
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2. Reis Soares OS, Duarte ML. Tarsal tunnel syndrome: clinical insights, vascular etiologies, and the role of ultrasonography in the diagnosis. Radiol Bras. 2025;58:e20250053. https://doi.org/10.1590/0100-3984.2025.0053
3. de Souza Reis Soares O, Duarte ML, Brasseur JL. Tarsal tunnel syndrome: an ultrasound pictorial review. J Ultrasound Med. 2022;41(5):1247-1272. https://doi.org/10.1002/jum.15793
4. Spinner RJ, Scheithauer BW, Amrami KK. Medial plantar nerve compression by a tibial artery schwannoma. Case report. J Neurosurg. 2007;106(5):921-923. https://doi.org/10.3171/jns.2007.106.5.921
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Data Availability Statement
The data supporting the findings of this case report are available from the corresponding author upon reasonable request. Due to patient privacy considerations, the data are not publicly available.
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Copyright (c) 2026 Gabriela Guedes Martins, Clara Rosa Ventura, Márcio Luís Duarte
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