The distal tarsal tunnel is the continuation of the tarsal tunnel beneath the flexor retinaculum, where the tibial nerve divides into the medial plantar, lateral plantar, and medial calcaneal nerves. The distal tunnel contains the FHL, FDL, and tibialis posterior tendons alongside the neurovascular bundle.
Tarsal tunnel syndrome produces medial ankle and plantar foot burning and numbness from tibial nerve compression under the flexor retinaculum. The proximal tarsal tunnel (at the medial malleolus) is the most common compression site, but distal compression at the master knot of Henry (where FDL and FHL cross) is also clinically significant. Tinel's sign at the medial ankle reproduces the symptoms. Surgical tarsal tunnel release must address all compartments of the tunnel.
Tibial nerve compression in the tarsal tunnel producing plantar burning, numbness, and intrinsic foot muscle weakness, confirmed by nerve conduction studies and managed by tarsal tunnel surgical decompression.
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