American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a common symptom of tarsal tunnel syndrome?

1. Pain worsened by walking and standing

2. Localized swelling around the ankle

3. Numbness in the big toe only

4. Pain that eases with increased activity

The correct answer is: Pain worsened by walking and standing

A common symptom of tarsal tunnel syndrome is pain that worsens with walking and standing. This condition occurs when the posterior tibial nerve is compressed as it travels through the tarsal tunnel, which is located behind the medial malleolus of the ankle. Activities that involve weight-bearing or prolonged standing typically aggravate the pain due to increased pressure on the nerve. Patients may describe the pain as burning or sharp, and it often radiates into the foot. The other options present symptoms that are not characteristic of tarsal tunnel syndrome. Localized swelling around the ankle does not typically occur with this syndrome, as the primary issue is related to nerve compression rather than an inflammatory process in the ankle itself. Numbness in the big toe only suggests a more specific nerve involvement that may indicate other conditions, as tarsal tunnel syndrome usually affects multiple toes and the sole of the foot. Lastly, pain that eases with increased activity contradicts the typical presentation of this syndrome, where symptoms generally worsen with activity.