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Tarsal tunnel syndrome secondary to accessory or variant muscles: a clinical and anatomical systematic review

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Abstract

Purpose

Many etiologies are known to lead to a tarsal tunnel syndrome (TTS). One rare cause is mass-occupying lesions, and particularly accessory or variant muscles (AVM). This study aimed to systematically collect published clinical cases of TTS caused by AVM.

Methods

An electronic literature search was conducted from inception to April 2021. The diagnosis of AVM should be reported in one of the following methods: ultrasonography, magnetic resonance imaging (MRI), or per-operatively. Data extraction included types and prevalence of accessory muscles, clinical presentation and diagnosis, and treatment modalities. Twenty-five studies were identified with a total 39 patients (47 ankles).

Results

The prevalence of TTS was reported in only two studies (9%). Forty-nine AVM were identified with the accessory flexor digitorum longus being the most common (52%). The most common sign/symptoms were tenderness (78.7%), pain (82.9%), dysesthesia (57.4%), Tinel sign (44.6%), and a swelling (25.5%). Decompression and excision were the most commonly performed procedures. Four accessory/variant muscles in the ankle have the potential to induce a tarsal tunnel syndrome.

Conclusion

This review highlights the clinical and imagery specificities of TTS secondary to accessory or variant muscles. Mass-occupying etiology should be included in the list of differential diagnoses whenever a posterior tibial nerve compression is suspected.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon

    Kaissar Yammine, Jimmy Constantin Daher & Chahine Assi

  2. Foot and Ankle Division, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon

    Kaissar Yammine

  3. Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon

    Kaissar Yammine, Jimmy Constantin Daher & Chahine Assi

  4. Diagnostic Radiology Department, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon

    Esther Haykal Tannoury

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  1. Kaissar Yammine
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K Yammine: protocol/project development, data analysis and manuscriot editing; CA: protocol/project development and manuscript editing; JD: data collection and manuscript writing and ET: data collection and manuscript writing.

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Yammine, K., Daher, J.C., Tannoury, E.H. et al. Tarsal tunnel syndrome secondary to accessory or variant muscles: a clinical and anatomical systematic review. Surg Radiol Anat 44, 645–657 (2022). https://doi.org/10.1007/s00276-022-02932-9

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