When lightning strikes twice: Tarsal tunnel syndrome in the presence of soleal sling syndrome

Abstract

Compression of the tibial nerve can occur at any point along its path through the lower extremity, including the soleal sling. Soleal sling syndrome and tarsal tunnel syndrome exhibit similar symptoms, namely foot paresthesias or numbness. A review of current literature found that soleal sling syndrome is rarely reported, and only neurolysis techniques are discussed as treatment. The purpose of this case study is to review the correction of proximal and distal tibial nerve compression using concomitant soleal sling and tarsal tunnel decompressions. A 55-year-old male experiencing left foot numbness and paresthesias for one year was evaluated over five visits between February and July 2022. Geisinger podiatrists determined the patient had a positive Tinel sign to the tibial nerve at the tarsal tunnel level and paresthesia upon palpation at the soleal sling level radiating to his toes. Surgical release of the soleal sling, concomitant with a traditional tarsal tunnel release, successfully treated tibial nerve compression, such that the patient has reported symptom improvement 12 months post-operatively. This case study shows that utilizing proximal and distal tarsal tunnel decompressions together, when appropriate, can resolve persistent symptoms.

Keywords

• IV