Filiz AZMAN-İSTE, Berfe Simya ÖZBEK
Cyprus Journal of Medical Sciences - 2026;11(5):378-383
BACKGROUND/AIMS: Anterior tarsal tunnel syndrome (ATTS) is an uncommon entrapment neuropathy of the deep peroneal nerve that is frequently overlooked in clinical practice. Prayer-related and ground-sitting postures, which are culturally common in Türkiye, may predispose individuals to this condition. This study aims to evaluate the prevalence, clinical characteristics, and electrophysiological features of asymptomatic ATTS identified incidentally during routine electromyography (EMG) examinations. MATERIALS AND METHODS: The records of 3,610 patients who underwent electrophysiological evaluation between January 2025 and February 2026 were retrospectively reviewed. Patients with electrophysiological evidence of distal deep peroneal nerve involvement without ATTS-related symptoms were included. L5 radiculopathy, proximal peroneal neuropathy, and polyneuropathy with motor fiber involvement were excluded. RESULTS: Asymptomatic ATTS was identified in 21 patients (0.58%). The mean age was 56.1+/-11.9 years; 11 were female and 10 were male. All patients reported prolonged plantar-flexion postures, mainly prayer-related sitting habits (namaz), with a mean duration of 15 years. Ten patients had diabetes mellitus. On the affected side, mean extensor digitorum brevis (EDB) distal motor latency was 5.19+/-1.57 ms and mean compound muscle action potential amplitude was 1.04+/-0.52 mV, compared to 4.47+/-0.8 ms and 3.08+/-1.52 mV on the contralateral side. Tibialis anterior (TA) motor responses were normal bilaterally. Needle EMG demonstrated neurogenic changes confined to the EDB muscle in all patients. CONCLUSION: Asymptomatic ATTS may be encountered more frequently in EMG practice than is generally appreciated. Prayer-related and ground-sitting postures may predispose individuals to ATTS. Systematic electrophysiological evaluation, including TA recording and needle EMG, may reduce misdiagnosis of polyneuropathy or lumbosacral radiculopathy in daily practice.
