Execution
- 1Position the patient supine or sitting with the ankle accessible.
- 2Place the ankle into plantarflexion and inversion.
- 3Apply direct digital pressure over the tarsal tunnel behind the medial malleolus.
- 4Maintain the combined position and pressure for approximately 30 seconds.
- 5Ask whether paresthesia or pain is reproduced in the tibial nerve distribution.
Positive outcome
Reproduction of pain, numbness, or paresthesia in the tarsal tunnel distribution is positive. The test combines position and pressure to compress the posterior tibial nerve. Symptoms should be mapped to the plantar foot or tibial nerve branches.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Abouelela et al. (2012) | NA | 85.9 | 100 | infinity | 0.14 |
CommentTriple compression has promising values in the original study, but 100% specificity creates an infinite LR+ that should be treated as small-sample optimistic until replicated. It is more targeted than simple Tinel percussion because it combines compression with positional narrowing. Use it as a rule-in support, not as the only diagnostic basis.
High Clinical Value