American Society for Peripheral Nerve

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Tibial nerve compression at the tarsal tunnel in both diabetic and non-diabetic subjects
Willem D. Rinkel, MD1,2; Manuel Castro Cabezas, MD, PhD1; Erwin Birnie, PhD1; J Henk Coert, MD, PhD1,3; (1)Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands, (2)Erasmus Medical University Center, Rotterdam, Netherlands, (3)University Medical center Utrecht, Utrecht, Netherlands


Introduction: Nerve entrapments like carpal tunnel syndrome are more prevalent in patients with diabetes compared to the general population, especially in those with complaints of diabetic sensorimotor polyneuropathy (DSP). The prevalence of tibial nerve compression at the tarsal tunnel has not been studied extensively yet. Its diagnosis is essential, as therapeutic interventions directed toward relief of entrapment may be effective regardless of the presence of DSP. Our study aim was to determine the prevalence of tibial nerve compression and its associated clinical impairments, in both a diabetic and non-diabetic population.

Materials & Methods: Data of 416 patients (240 non-neuropathic subjects with diabetes and 176 diabetic subjects with neuropathy) participating in the prospective Rotterdam Diabetic Foot Study and 196 reference subjects without diabetes and without neuropathy were evaluated for clinical features of tibial nerve compression at the tarsal tunnel. All subjects underwent sensory testing of the feet and complaints were assessed using the Michigan Neuropathy Screening Instrument.

Results: The prevalence of clinical tibial nerve compression in diabetic patients was 44.9% (CI: 40.1-49.7%) vs. 26.5% (CI: 20.3-32.7%) in healthy controls (p < .0001). The prevalence of bilateral compression was higher in diabetic patients with neuropathy complaints (MNSI 4) 34.5% (CI: 26.7-42.2%) vs. 23.4% (CI: 17.5-29.2%), p = .024). In diabetic patients, unilateral tarsal tunnel syndrome (TTS) was present in 29.9% (CI: 25.2-34.5%), and bilateral TTS in 17.7% (CI: 13.9-21.5%). Significant more neuropathic symptoms (p < .002) and higher sensory thresholds were observed in tibial nerve innervated areas, when compressed.

Conclusions: Tibial nerve compression is prevalent in both diabetic subjects and controls. The significant more frequently reported neuropathic complaints and concomitant sensory disturbances suggests a role for super-imposed entrapment neuropathy in diabetes related neuropathy.

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