Tarsal Tunnel Syndrome

Patient presents with complaints consistent with tarsal tunnel syndrome (TTS).  Symptoms include pain, numbness, tingling, burning, and or paresthesia in the medial ankle, heel, arch, and plantar aspect of the foot, often radiating to the toes.  Onset of symptoms may be insidious or related to a specific event such as ankle sprain or fracture.  Symptoms are often worse at night or with prolonged weight-bearing and activity.  Physical examination reveals positive Tinel's sign at the tarsal tunnel with percussion eliciting paresthesias distally.  Sensory testing may demonstrate diminished sensation in the distribution of the tibial nerve.  Motor weakness, particularly involving the intrinsic foot muscles, may be present in advanced cases.  Differential diagnoses include plantar fasciitis, nerve entrapment elsewhere in the leg, and peripheral neuropathy.  Assessment includes electrodiagnostic studies (nerve conduction velocity study and electromyography) to confirm the diagnosis of tarsal tunnel syndrome and rule out other conditions.  Initial treatment plan consists of conservative management including rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDs), orthotics for arch support, and physical therapy focusing on stretching and strengthening exercises.  Corticosteroid injection into the tarsal tunnel may be considered for symptom relief.  Surgical decompression of the tarsal tunnel is indicated if conservative measures fail to provide adequate relief.  Patient education regarding activity modification, proper footwear, and potential complications is crucial.  Follow-up care is scheduled to monitor symptom progression and treatment effectiveness.  ICD-10 code G57.3, CPT codes for potential procedures include 27000 (ankle injection), 64721 (tarsal tunnel release).