Peripheral nerve injuries: anterior tarsal tunnel syndrome: practice question

A Orthopaedics 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.

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Orthopaedics · Peripheral nerve injuries: anterior tarsal tunnel syndrome

Sample item

A runner who laces her shoes tightly has burning pain and numbness restricted to the first web space on the dorsum of the foot. The symptoms are reproduced by tapping over the front of the ankle. Which nerve is entrapped?

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

The answer and the reasoning

B. Deep peroneal nerve under the inferior extensor retinaculum

In anterior tarsal tunnel syndrome the deep peroneal nerve is compressed beneath the inferior extensor retinaculum, giving a first web space sensory deficit, weak extensor digitorum brevis and pain on the dorsum of the foot, often from tight footwear. The posterior tarsal tunnel instead involves the tibial nerve.

Option by option

  • A. Tibial nerve under the flexor retinaculum

    Tibial nerve compression behind the medial malleolus gives plantar burning, not first web space numbness.

  • B. Deep peroneal nerve under the inferior extensor retinaculum (correct)

    Correct. The deep peroneal nerve supplies the first web space and passes under the inferior extensor retinaculum.

  • C. Superficial peroneal nerve at the fascial exit

    The superficial peroneal nerve supplies most of the dorsum of the foot, sparing the first web space.

  • D. Sural nerve behind the lateral malleolus

    The sural nerve supplies the lateral border of the foot and is not related to the extensor retinaculum.

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.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is B, Deep peroneal nerve under the inferior extensor retinaculum. In anterior tarsal tunnel syndrome the deep peroneal nerve is compressed beneath the inferior extensor retinaculum, giving a first web space sensory deficit, weak extensor digitorum brevis and pain on the dorsum of the foot, often from tight footwear.

Why is "Tibial nerve under the flexor retinaculum" not the answer?

Tibial nerve compression behind the medial malleolus gives plantar burning, not first web space numbness.

Why is "Superficial peroneal nerve at the fascial exit" not the answer?

The superficial peroneal nerve supplies most of the dorsum of the foot, sparing the first web space.

Why is "Sural nerve behind the lateral malleolus" not the answer?

The sural nerve supplies the lateral border of the foot and is not related to the extensor retinaculum.

What concept does this question test?

It tests Peripheral nerve injuries: anterior tarsal tunnel syndrome in Orthopaedics. The posterior tarsal tunnel instead involves the tibial 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 Peripheral nerve injuries: anterior tarsal tunnel syndrome?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics 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.