Occupational tarsal tunnel syndrome.

Tarsal tunnel syndrome characterises a complex of symptoms that result from compression of the posterior tibial nerve as it passes through the fibro-osseus tunnel located beneath the flexor retinaculum on the medial aspect of the ankle.' The syndrome has been described in several case reports and review articles24 since Keck's5 and Lam's6 original case reports in 1962. Whereas other nerve entrapment syndromes are known to be caused by activities including repetitive motion of the hands and feet and are frequently occupational, no similar relation has been described for the tarsal tunnel syndrome. Lam looked for common risk factors among a series of ten patients with tarsal tunnel syndrome but found that none shared a common occupation.' Davies, in a personal communication to Lam, noted that several of his own patients with tarsal tunnel syndrome were jockeys. Tarsal tunnel syndrome was one of the many foot disorders described in a clinical survey of dancers by Sammarco and Miller.7 We present a case of tarsal tunnel syndrome in a seamstress that appears to have been caused by a repetitive trauma injury that occurred in the workplace. Case report The patient is a 53 year old woman who was referred to our occupational medicine clinic by a general practitioner to determine whether or not her nerve entrap-ment syndrome was related to work. The patient had no symptoms until August 1985 when she developed pain in the medial aspect of her right foot. The pain increased in severity until February 1986 when she was unable to sleep, sitting up in a chair for relief. At that time she underwent surgery to lyse the adhesions which had encased the posterior tibial nerve and prevented its movement within the tarsal tunnel. The pain resolved immediately after the operation and the patient remained free of pain until May 1986 when her symptoms recurred. She underwent physical therapy and received a corticosteroid injection without relief.