Tarsal Tunnel Syndrome in Children with Mucopolysaccharidosis: An Egyptian Center Study

Abstract

Background: Tarsal tunnel syndrome (TTS) is compression of the posterior tibial nerve as it passes inferiorly to the flexor-retinaculum in its fibro-osseous tunnel. We aimed to assess early detection of TTS in children with mucopolysaccharidosis (MPS) to help intervention at the proper time. Methods: This cross-sectional study was performed on 40 pediatric patients with MPS patients (aged 1-18 years), who were receiving regular enzyme replacement therapy (ERT), were exposed to systemic clinical examination, appropriate laboratory and radiological evaluation, electrophysiological studies, and posterior tibial nerve motor conduction study. Results: Among 40 children with MPS (median age 7 years; 62.5% male), MPS type I was most common (42.5%). All patients had joint stiffness and coarse facies; corneal clouding and hepatosplenomegaly were observed in 67.5% and ~45%, respectively. Growth impairment worsened with age, particularly in weight and height, while head circumference remained relatively preserved. Electrophysiological studies showed normal posterior tibial nerve conduction with no TTS observed in any of the patients. Conclusions: TTS was a very rare entrapment of neuropathy in the general population and in MPS patients