Triple Compression Stress Test | Tarsal Tunnel Syndrome (TTS)

Tarsal Tunnel syndrome is a compressive neuropathy of the posterior tibial nerve or its branches, which can become entrapped in the tarsal tunnel under the deep fascia, flexor retinaculum and within the abductor hallucis muscle.

According to Abouelela et al. (2012), the Triple Compression Stress Test has a sensitivity of 85,9% and a specificity of 100%. For this reason, it seems that this test has a high clinical value to confirm and exclude Tarsal Tunnel Syndrome, although we have to be careful as there has only been one study evaluating this test.

To conduct the test, have your patient in supine lying position. Then maximally plantarflex the ankle, bring the foot and the heel into maximal inversion and compress the posterior tibial nerve posterior to the medial malleolus with your fingers.

This compression is applied for 30 seconds. This test is positive if the patient complains about numbness, paresthesia, or pain in the toe, ball of the foot, and/or heel.

Other orthopedic tests to assess tarsal tunnel syndrome are:

• Tinel’s Sign at the Ankle
• Dorsiflexion-Eversion Test

Abouelela, A. A., & Zohiery, A. K. (2012). The triple compression stress test for diagnosis of tarsal tunnel syndrome. The Foot, 22(3), 146-149.