Unravelling the spatial relationships and inconsistencies of the tarsal tunnel: a comprehensive review and analysis

Tarsal tunnel anatomy is presumed to be well understood, but there is clearly a lack of precision in existing literature. This is an important admission, as tarsal tunnel syndrome (TTS) remains poorly treated, with up to 79% of patients reporting negative outcomes to their treatment. There is no gold standard approach to diagnosis and treatment of TTS, which, in part, may be due to presumed anatomical details and a lack of precise anatomical understanding. This review emphasizes and explores the various and inconsistent reports of the structures coursing through and forming the boundaries of the tarsal tunnel. It is evident that there is no consistency in the techniques utilized to assess these structures, resulting in a limited understanding of the precise anatomy of the tarsal tunnel. The anatomy presented in textbooks is not strongly supported by anatomical research, but textbooks provided the most detailed visualizations of the tunnel. The reviewed literature offered provided contrasting descriptions from the textbooks, but no consensus was found, and image style and quality differed greatly. The overall relations of the tarsal tunnel and detailed features of the tunnel are therefore poorly represented visually. This review includes original schematic figures to present previously reported data, demonstrating the inconsistencies within the literature. A more accurate approach for assessing the tarsal tunnel as an overall unit is required. This will facilitate future developments of techniques used to diagnose, manage and treat TTS.