Tarsal tunnel syndrome associated with a perforating branch from posterior tibial artery: a case report

Tarsal Tunnel Syndrome Associated With a Bipartite Talus

BACKGROUND

Talus bipartitus is a rare skeletal anomaly that may be mistaken for an os trigonum, a relatively common accessory ossicle found posterior to the talus. Both are believed to be formed similarly with the failed fusion of the talus with a second ossification center. Os trigonum is often diagnosed incidentally or found on radiographs obtained in symptomatic patients with signs of os trigonum syndrome, which presents with posterolateral ankle pain. A bipartite talus may also present with similar symptoms but may be differentiated through its articular involvement.

CASE

In this article, we describe the rare presentation of tarsal tunnel syndrome in a patient caused by a bipartite talus. The patient underwent surgical decompression with the removal of the posterior fragment.

CONCLUSION

A bipartite talus is a rare entity that may be mistaken for an os trigonum, a common accessory ossicle. In this article, we describe an outcome of a bipartite talus fragment removal due to tarsal tunnel syndrome and illustrate a rare pathological consequence of a bipartite talus. We further highlight the importance of early surgical management in patients presenting with an identifiable structure contributing to tibial nerve compression.

Septic True Aneurysm of the Posterior Tibial Artery Diagnosed after Anterior Arthroscopic Debridement of a Septic Ankle following Infective Endocarditis: A Case Report

Introduction

There have been reports of true aneurysm of the posterior tibial artery, but only three reports have described true aneurysm of the posterior tibial artery at the ankle, and there has been only one report of tarsal tunnel syndrome caused by true aneurysm of this artery. In this case report, we describe a rare case of true septic aneurysm of the posterior tibial artery presenting as tarsal tunnel syndrome which was found after anterior arthroscopic debridement of a septic ankle in a 55-year-old man.

Case Report

13 years earlier, this patient had undergone aortic valve replacement for severe aortic regurgitation caused by infective endocarditis with aortic valve vegetations. Since then, the patient had been treated with the oral anticoagulant warfarin. The aneurysm was successfully treated by a saphenous vein graft and administration of antibiotics. The patient likely developed septic ankle and aneurysm as a consequence of infective endocarditis.

Conclusions

Magnetic resonance imaging should be performed before arthroscopic surgery to rule outaneurysm, especially in a patient with a septic ankle and/ora history of infective endocarditis.