Execution
- 1Position the patient sitting or supine with the medial ankle exposed.
- 2Identify the posterior tibial nerve behind the medial malleolus and beneath the flexor retinaculum.
- 3Tap or percusses gently along the tarsal tunnel.
- 4Ask whether tingling, paresthesia, or pain radiates into the medial plantar, lateral plantar, heel, or sole distribution.
- 5Compare with the opposite side and note sensory or motor findings in the foot.
Positive outcome
Radiating paresthesia or pain into the tibial nerve distribution of the foot is positive. Local tenderness at the tapping site alone is not sufficient. Symptoms may be worse after standing, walking, or at night in tarsal tunnel presentations.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Kinoshita et al. (2001) | NA | NA | NA | NA | NA |
CommentMagee includes Tinel's sign at the ankle as part of the ankle-foot special-test screen. Tinel is clinically familiar but has limited standalone validation for tarsal tunnel syndrome. Use it with dorsiflexion-eversion, triple compression, sensory distribution, motor findings, and consideration of double-crush or plantar fasciitis mimics.
Low Clinical Value