A 45-year-old woman presents with medial ankle pain and paresthesia radiating to the sole of the foot. Symptoms worsen with prolonged standing and walking. Tinel's sign is positive posterior to the medial malleolus. Nerve conduction studies show prolonged distal motor latency of the tibial nerve. The most appropriate initial management is:

• A Surgical tarsal tunnel release
• B Corticosteroid injection into the tarsal tunnel
• C MRI of the lumbar spine
• D Conservative treatment with orthotics, NSAIDs, and activity modification ✓

Explanation

Tarsal tunnel syndrome is entrapment of the posterior tibial nerve beneath the flexor retinaculum. Initial management is conservative: activity modification, NSAIDs, orthotics to correct any pes planus contributing to nerve compression, and possibly a corticosteroid injection. Surgery is reserved for cases failing 3-6 months of conservative treatment. MRI of the lumbar spine is not indicated as the diagnosis is confirmed by positive Tinel's sign and abnormal nerve conduction studies localizing to the tarsal tunnel.

Reference: Canale and Beaty's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.