Medical Student: Case Report: Numb Toes-Case report

Case report

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This document details a clinical case study involving a 48-year-old female patient presenting with numbness in the first four toes of her right foot along with severe back pain. The diagnosis identified is Tarsal Tunnel Syndrome, a condition involving compression of the tibial nerve as it passes through the tarsal tunnel in the ankle. The case was prepared by clinicians from UMDNJ‐New Jersey Medical School and aims at educating residents and fellows in neurology.<br /><br />Initially, a broad differential diagnosis included conditions like lumbar radiculopathy, tibial nerve injury, and plantar fasciitis. The patient's history of sharp low back pain combined with MRI findings of minimal degenerative changes and bilateral neural foraminal stenosis at L5-S1 increased the suspicion for lumbar radiculopathy. However, her physical examination revealed positive Tinel’s sign at the tarsal tunnel and reduced sensation in toes, making tarsal tunnel syndrome more likely. <br /><br />Electrophysiological studies confirmed abnormalities in the right medial plantar nerve indicative of tarsal tunnel syndrome while ruling out more proximal nerve pathologies such as S1 radiculopathy. The studies recorded diminished amplitudes of motor responses in the area affected.<br /><br />The document further explains that within the tarsal tunnel, structures like tendons and blood vessels create a space that can compress the tibial nerve, exacerbating symptoms like numbness and pain due to ischemia caused by increased pressure. Anatomic variations, such as proximal bifurcation of the posterior tibial nerve seen in some individuals, might contribute to increased risk for this syndrome. <br /><br />The patient was recommended for podiatric evaluation, potentially considering tarsal tunnel release surgery. This case serves as an educational tool, emphasizing the importance of comprehensive diagnostic evaluation in presenting lower extremity nerve issues.

Keywords

Tarsal Tunnel Syndrome

tibial nerve compression

neurology education

lumbar radiculopathy

Tinel's sign

electrophysiological studies

medial plantar nerve

nerve ischemia

podiatric evaluation

tarsal tunnel release surgery