The patient came to the clinic 15-April-2015 complaining of left foot pain for three months with minimal LBP. MRI lumbar spine done 24-March-2015 was normal. EMG study performed 15-March-2015 confirming tarsal tunnel syndrome left foot.

On examination: the patient is limping as protecting her left foot. Inspection of the posterior tibial nerve showed agonizing pain when pressing and tapping the inferior part of the flexor retinaculum. There are no varicose veins. There are no skin changes. Durkan test positive. Eversion of the foot produced pain. There is hypalgesia of the medial and lateral aspect of the left foot.

Projectional incision over the left posterior tibial nerve. The flexor retinaculum was identified and bisected. The neuro-vascular bundle immediately relaxed. Dissection of the posterior tibial nerve and the medial and lateral palmar branches were followed inferior until they were reached to the most distal attributes. Without extending the incision up, the posterior tibial nerve was dissected 10 cm above the incision. It looks that the medial calcaneal nerve was originating more distal, for what its exploration was ignored, since it was not included in the retinaculum , nor there was no clinical evidence supporting its involvement.

Smooth postoperative recovery. It is early to detect the results since vigorous dissection was performed during surgery.

The patient still complaining of left foot pain due to incision.

The patient has typical manifestations of TTS, which is not responding to conservative measures. Release is the only solution.