Tarsal Tunnel Syndrome: Electrodiagnostic Diagnosis and Differentials
The Clinical & Business Connection Newsletter
Clinical Insight
Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the posterior tibial nerve as it passes behind the medial malleolus. Patients present with burning, numbness, or tingling along the plantar foot — symptoms that overlap significantly with plantar fasciitis, peripheral neuropathy, and lumbosacral radiculopathy. Electrodiagnostic testing is the most direct means of resolving that diagnostic ambiguity.
What EMG/NCS Adds
NCS of the medial and lateral plantar nerves can demonstrate prolonged distal latency or reduced SNAP amplitude, confirming focal nerve compromise at the entrapment site. EMG of the intrinsic foot musculature reveals denervation changes consistent with tibial nerve involvement. These findings localize the lesion, characterize its severity, and distinguish peripheral entrapment from radiculopathy or polyneuropathy — information imaging cannot reliably provide.
Key Differentials
- Peripheral neuropathy: length-dependent, bilateral, symmetric slowing — not focal at the tarsal tunnel
- L4–S1 radiculopathy: paraspinal or proximal denervation on EMG; plantar NCS often normal
- Plantar fasciitis: EMG/NCS normal — most useful for ruling out a neurogenic component
- Baxter’s neuropathy: isolated abductor digiti minimi denervation with normal medial plantar NCS
Refer for electrodiagnostic evaluation when foot numbness persists despite standard care, when the differential is unclear, or when surgical planning requires objective nerve severity data.
References
- Antoniadis G et al. Tarsal tunnel syndrome: diagnosis and treatment. Dtsch Arztebl Int. 2008.
- Oh SJ. Nerve conduction in tarsal tunnel syndrome. Muscle Nerve. 1984.
- AANEM. Recommended policy for electrodiagnostic medicine. Muscle Nerve. 1999.
Business Success Strategy
Important Reminder: Check Your Medicare Revalidation Status
CMS requires Medicare providers to periodically revalidate their enrollment information — generally every five years. During revalidation, providers must confirm or update ownership details, practice locations, managing employees, and contact information.
While your Medicare Administrative Contractor may send a reminder notice, CMS places the responsibility for tracking revalidation deadlines on the provider. Missing the deadline can result in deactivation of Medicare billing privileges — meaning Medicare will not reimburse services rendered during the deactivation period.
Action Steps
- Check your revalidation due date now: data.cms.gov/tools/medicare-
revalidation-list - If revalidation is due, submit electronically through PECOS — you can review your file, upload documents, sign, and submit online
- Submit well before your deadline. Do not wait for a reminder notice
This is a simple check that takes only a few minutes — and avoids a potentially significant billing disruption!
Spotlight on Excellence
Updates You Should Know
The Introduction to EMG, Nerve Conduction Studies, and Musculoskeletal Ultrasound Imaging course just wrapped — and it was a phenomenal success.
This month, Hands-On EMG Testing hosted the American Academy of Clinical Electrodiagnosis (AACE) and the American Academy of MSK Ultrasound (AAMU) for the Introduction to EMG, Nerve Conduction Studies, and Musculoskeletal Ultrasound Imaging with 40+ clinicians gathering for two days of intensive, hands-on training.
Attendees left with:
- Real-world skills in EMG, nerve conduction studies, and MSK ultrasound imaging
- The clinical context needed to make more confident, accurate referrals
- 20.5 CEUs (physical therapy professionals) or 20.5 CMEs (physicians and medical providers)
- A direct connection to the HODS Leadership Team, who works personally with your admin and marketing staff to tailor strategies for your practice and market
The energy in the room was electric — and the demand is only growing!
Want in on the next one? For all upcoming dates and locations please visit emgintro.com.
How We Can Help
Hands-On EMG Testing serves physicians and patients across several locations in Manhattan, Queens, the Bronx, Brooklyn, and Long Island.
To refer a patient, please use our online referral form. To learn more about our services, email in**@********mg.com, or call +1 (855) 248-4021.
If you are interested in incorporating our Medical Diagnostic Model into your practice to provide immediate testing results and create a strong business opportunity, please contact Dr. Dimitrios Kostopoulos at di**@********mg.com.
