| Introduction |
- Caused by impingement of DPN by distal margin of inferior extensor retinaculum
- also known as anterior Anterior Tarsal Tunnel Syndrome
- Causes of impingement include
- dorsal osteophytes over apex of medial longitudinal arch
- ganglion cyst
- tight laces or ski boots
- Anatomy
- anterior tarsal tunnel contains
- EDL
- EHL
- Tibialis anterior
- Deep peroneal nerve
- dorsalis pedis artery
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| Presentation |
- Symptoms
- dysesthesia and paresthesias on dorsal foot and first web space are most common
- vague foot pain
- Physical exam
- Tinel sign with symptoms in first web space
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| Treatment |
- Nonoperative
- shoe modifications
- indications
- techniques
- well padded tongue on shoe
- full length rocker-sole steel shank
- Operative
- surgical release of DPN by releasing retinaculum and osteophyte / ganglion resection
- indications
- failure of nonoperative treatment
- symptoms of RSD are a contraindication to release
- technique
- start distal, identify nerve, and release it proximally (nerve lies lateral to EHB)
- warn patient that recovery is prolonged
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