Patients with a cavus foot deformity, peripheral neuropathies, or previous ligamentous injuries from sprains may be predisposed to excessive stresses on the midfoot and early osteoarthritic changes. Tarsal tunnel syndrome is caused by entrapment of the posterior tibial nerve under the flexor retinaculum on the medial side of the ankle. Symptoms of pain and paresthesia over the plantar and distal foot and toes are usually present, and Tinel's sign may be positive. Tarsal tunnel syndrome is much less common and more difficult to diagnose than carpal tunnel syndrome in the wrist. Local glucocorticoid injection and surgical decompression are not as predictably successful as in carpal tunnel syndrome.
Patients report pain over the plantar aspect of the heel and midfoot that worsens with walking.
Localized tenderness along the plantar fascia or at the insertion of the calcaneus is helpful in diagnosis. Plantar fasciitis is associated with obesity, pes planus, and activities that stress the plantar fascia and may also be seen in systemic arthropathies such as ankylosing spondylitis and Reiter's syndrome. Although radiographic spurs in the affected area are common, they may also be seen in asymptomatic persons and are therefore not diagnostic. Posterior heel pain is usually caused by Achilles tendinitis or by bursitis of the bursas that lie superficial or deep to the insertion of the Achilles tendon at the calcaneus. Although usually associated with overactivity, Achilles tendinitis may also be part of ankylosing spondylitis and Reiter's syndrome.