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Group D Case Study 4

Group D Case Study 4 . Rebecca Bennet Claire Crutchley Harm Kallu Hilary Short Nicky Weston. Scenario. 46 year old female Referred by GP Complaining of severe pain in the bottom of right foot No medication at present Has noticed tingling and numbness in some toes at times.

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Group D Case Study 4

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  1. Group DCase Study 4 • Rebecca Bennet • Claire Crutchley • Harm Kallu • Hilary Short • Nicky Weston

  2. Scenario • 46 year old female • Referred by GP • Complaining of severe pain in the bottom of right foot • No medication at present • Has noticed tingling and numbness in some toes at times

  3. Symptoms seem to indicate Tarsal Tunnel Syndrome due to following clinical presentations; • Location and severity of pain • Numbness and tingling in some toes • Pain is unilateral (Mooney & Campbell 2010)

  4. However… Tarsal Tunnel Syndrome is often misdiagnosed! Nature of symptoms mean that there are many other pathologies with symptoms paralleling this condition (Yates 2009)

  5. Differential Diagnosis • Polyneuropathy • Morton’s metatarsalgia • Compartment syndrome of deep flexor compartment • Calcaneal spur • Arthrosis of joints of foot • Plantar fasciitis • Inflammatory changes to ligaments Not an exhaustive list! (Antoniadis & Scheglmann 2008)

  6. A variety of soft-tissue, osseous and systemic disorders can cause heel pain Common misdiagnosis include; • Plantar Fasciitis • Achilles Tendonitis • Retrocalcaneal Bursitis (Morphopedics.com, n.d.)

  7. The Tarsal TunnelThe tarsal tunnel is a structure of the foot that is formed between the underlying bones and the overlying fibrous tissue of the flexor retinaculum.(Mooney & Campbell 2010)(Image from www.orthogate.org) Picture of tarsal tunnel

  8. What is Tarsal Tunnel Syndrome? It is a relatively uncommon entrapment neuropathy caused by damage to and/or compression of the posterior tibial nerve within the tarsal tunnel (Mooney & Campbell 2010, p 122) Presenting symptoms include; • Sharp, shooting foot pain • Numbness on sole of foot • Radiation of pain/paraesthesia along course of nerve (Patient.co.uk)

  9. Short term plan Conservative management focuses on therapies to reduce unpleasant and painful symptoms including; • Clinical padding such as valgus filler pads or medial heel wedges • Orthosesor bespoke shoes • Injections of corticosteroids into tarsal tunnel • Medication for pain • Exercises to maintain muscle strength • Control of any underlying contributory conditions (Mooney & Campbell 2010, p 122)

  10. Long term plan • If job involves standing – job counselling could be suggested? • Failure of conservative treatment means surgical intervention could be indicated • Surgery can enlarge the tarsal tunnel and reduce the pressure on the tibialnerve • Varied success rates! (Antoniadis & Scheglmann2008) (Image from foot&ankleinstitue.com)

  11. Thank you for listening ANY QUESTIONS?

  12. References Antoniadis G and Scheglman K (2008) Posterior Tarsal Tunnel Syndrome. Deutsches International 105 (45): 776-781 Mooney J and Campbell R (2010) Adult Foot Disorders IN: Frowan P, O’Donnell M, Lorimer DL and Burrow G (eds) Neale’s Disorders of the Foot. London: Churchill Livingstone 82-142 Morphopedics (n.d.) Tarsal Tunnel Syndrome. Availablr from: http://morphopedics.wikidot.com [Accessed 8th April 2012) Patient.co.uk (2012) Tarsal Tunnel Syndrome. Available from: http://www.patient.co.uk [Accessed 9th April 2012] Yates B (2009) Merriman’s Assessment of the Lower Limb (3rd Edition) London: Churchill Livingstone

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