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A 56-year-old man has pain and tingling in the medial aspect of his ankle and the plantar aspect of his foot. He jogs 3 miles daily and has no history of any injury. The symptoms are aggravated by activity and sometimes keep him awake at night. The only findings on examination are paresthesias when a reflex hammer is used to tap just inferior to the medial malleolus. Which of the following is the most likely diagnosis?

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Answer: Tarsal tunnel Syndrome

Explanation: Tarsal tunnel syndrome is caused when the tibial nerve is being compressed. This nerve is present in the ankle and it allows feeling and movement to parts of the foot. Tarsal tunnel syndrome can lead to numbness, tingling, weakness, or muscle damage. It is diagnosed by applying pressure (hence the hammer) to the tibial nerve. This will produce a tingling sensation (paresthesias).

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