Posterior Tibial Artery Compressing the Medial Plantar Nerve

Introduction: Tarsal tunnel syndrome (TTS) is a compressive neuropathy involving the posterior tibial nerve or its branches within the fibro-osseous tarsal tunnel. Vascular etiologies are underrecognized and may be overlooked in clinical assessment. Objective: To illustrate the diagnostic value of dynamic ultrasound in identifying clinically significant neurovascular compression in TTS. Case report: A 32-year-old woman presented with right ankle pain associated with intermittent electric shock–like sensations over the medial plantar aspect of the foot, exacerbated by prolonged walking. Physical examination revealed a positive Tinel sign along the medial plantar nerve. Ultrasound demonstrated close contact between the posterior tibial artery and the medial plantar nerve without other structural abnormalities, suggesting neurovascular compression. Conclusion: Vascular causes of TTS should be considered in patients presenting with plantar neuropathic symptoms. High-resolution ultrasound with color Doppler plays a key role in identifying neurovascular conflict and guiding clinical management.