Novel electrodiagnostic provocative techniques for the diagnosis of suspected tarsal tunnel syndrome

BACKGROUND: Electrodiagnostic tests (EDXTs) have been considered the gold standard method for the diagnosis of tarsal tunnel syndrome (TTS); however, definitive tests has not yet been discovered. Our aim was to develop new nerve conduction provocative techniques in the double and single leg stance as well as combined ankle dorsiflexion with foot eversion accompanied by compression for the diagnosis of suspected TTS. RESULTS: Routine combined nerve conduction studies (NCSs) using medial plantar (MP) and lateral plantar (LP) nerves had a 60.9% sensitivity for the diagnosis of TTS. The diagnostic sensitivity increased when combining the three novel tests reaching 82.6% and 78.3% using either MP or LP NCSs respectively. The diagnostic sensitivity further increased to reach 100% when combining the MP and LP novel NCSs considering either the latency or amplitude. CONCLUSION: The full diagnostic sensitivity for TTS reached 100% by using a battery of novel tests. The proposed diagnostic workup by this study recommends using these biomechanically challenging tests to complete the diagnostic battery of tests especially in symptomatic patients with negative routine tests.