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Fibromyalgia and Tinel’s Sign in the Foot

Linda Shookster, MD ^*, Gerald I. Falke, DPM , Ivica Ducic, MD, PhD  , Christopher T. Maloney, Jr., MD ^|| and A. Lee Dellon, MD  ^|| ¶

^* Division of Rheumatology, New York College of Podiatric Medicine, New York, NY.
Private practice, Hagerstown, MD.
Institute for Peripheral Nerve Surgery, Baltimore, MD.
Department of Plastic Surgery, Georgetown University Hospital, Washington, DC.
^|| Division of Plastic Surgery, University of Arizona, Tucson.
^¶ Division of Plastic Surgery, Johns Hopkins University, Baltimore, MD.

Corresponding author: A. Lee Dellon, MD, 3333 N Calvert St, Suite 370, Baltimore, MD 21218.

Abstract

In the physical examination of the patient suspected of having tarsal tunnel syndrome, the podiatric physician relies on Tinel’s sign: tapping the posterior tibial nerve in the tarsal tunnel should produce a distally radiating sensation if the nerve is pathologically compressed at this location. The American College of Rheumatology recognizes fibromyalgia as a condition characterized by multiple "tender points" on physical examination. This report compares the locations of the 18 critical diagnostic fibromyalgia points with known sites of anatomical entrapment of peripheral nerves in the lower extremity. We also describe a patient with both fibromyalgia and tarsal tunnel syndrome. Tinel’s sign in the lower extremity is a valid technique for assessing peripheral nerve compression in the patient with fibromyalgia. (J Am Podiatr Med Assoc 94(4): 400–403, 2004)