Anterior Tarsal Tunnel Syndrome (ATTS)

• Deep peroneal nerve (DPN)
• DPN impingement by distal inferior extensor retinaculum
• pts usually have dorsal osteophytes / ganglion over apex of medial longitudinal arch

ATTS Symptoms

• dysesthesias and paresthesias on dorsul of foot radiating into first web space
• Tinel’s sign over DPN
• decreased sensation in 1^st dorsal web space
• palpate DPN, compare sides

ATTS Treatment

• well-padded tonge shoe, loosely laced
• full-length rocker-sole steel shank @ 1/16” wide
• Surgery=locate DPN distally just lateral to EHB tendon, trace proximally releasing all fascial restraints.  Remove osteophyties or ganglion.  Surgery contraindicated if RSD present.

ATTS Complications

• continued parasthesias
• dysethesias
• RSD