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Tarsal Tunnel

Clinical case and images provided by Avneesh Chhabra, M.D., Johns Hopkins University School of Medicine, Baltimore, USA

Clinical question

41-year-old woman with heel pain.

  • Prior tarsal tunnel release many month ago

 

Clinical images

High trifurcation of TN - MPN (red), LPN (blue) and calcaneal nerve (yellow)
Accessory muscle in tarsal tunnel (orange)
3D DW PSIF with vessel suppression- MPN and LPN
MPN - Bright with focal enlargement
MPN - focal enlargement and hyperemic
LPN diffusely enlarged and hyperemic
Calcaneal nerve- enlarged and hyperemic

Interpretation

  • Accessory muscle missed on prior surgery, seen on MRN
  • Visualization of high trifurcation and abnormality of all three nerves (MPN, LPN and enlarged nerve) helped the surgeon
  • Clarification of calcaneal nerve and plantar nerves to help the surgeon
  • Diagnosis - Nerve re-entrapment and prior inadequate tarsal tunnel release

 

Consequences for treatment

  • Surgery performed again to resect the calcaneal nerve
  • Consequently improvement in symptoms

 

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