Lower limb: tarsal tunnel: practice question

A Anatomy question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

Anatomy · Lower limb: tarsal tunnel

Sample item

A 40-year-old runner has burning pain and numbness over the sole of the foot that worsens after standing. Percussion behind the medial malleolus reproduces the symptoms. Within the tunnel where the compressed nerve runs, which structure lies immediately anterior to the nerve?

APosterior tibial artery and veinsBTendon of tibialis posteriorCTendon of flexor hallucis longusDTendon of flexor digitorum longus

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Posterior tibial artery and veins

In the tarsal tunnel the contents from anterior to posterior are the tibialis posterior tendon, flexor digitorum longus tendon, posterior tibial vessels, tibial nerve and flexor hallucis longus tendon. The tibial nerve (or its terminal medial and lateral plantar branches) is compressed in tarsal tunnel syndrome. The vessels are therefore the structure directly in front of the nerve.

Option by option

A. Posterior tibial artery and veins (correct)
The posterior tibial vessels lie directly anterior to the tibial nerve in the tunnel.
B. Tendon of tibialis posterior
The tibialis posterior tendon is the most anterior content, next to the medial malleolus.
C. Tendon of flexor hallucis longus
The flexor hallucis longus tendon is the most posterior content, lying behind the nerve.
D. Tendon of flexor digitorum longus
The flexor digitorum longus tendon lies anterior to the vessels, so it is separated from the nerve by them.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is A, Posterior tibial artery and veins. In the tarsal tunnel the contents from anterior to posterior are the tibialis posterior tendon, flexor digitorum longus tendon, posterior tibial vessels, tibial nerve and flexor hallucis longus tendon.

Why is "Tendon of tibialis posterior" not the answer?

The tibialis posterior tendon is the most anterior content, next to the medial malleolus.

Why is "Tendon of flexor hallucis longus" not the answer?

The flexor hallucis longus tendon is the most posterior content, lying behind the nerve.

Why is "Tendon of flexor digitorum longus" not the answer?

The flexor digitorum longus tendon lies anterior to the vessels, so it is separated from the nerve by them.

What concept does this question test?

It tests Lower limb: tarsal tunnel in Anatomy. The tibial nerve (or its terminal medial and lateral plantar branches) is compressed in tarsal tunnel syndrome. The vessels are therefore the structure directly in front of the nerve.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Lower limb: tarsal tunnel?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.