American Board of Internal Medicine (ABIM) Certification Practice Exam

Which condition is associated with pain and paresthesias in the medial ankle?

1. Achilles tendinopathy

2. Tarsal tunnel syndrome

3. Ankle sprain

4. Plantar fasciitis

The correct answer is: Tarsal tunnel syndrome

The condition most closely associated with pain and paresthesias in the medial ankle is tarsal tunnel syndrome. This syndrome occurs when the tibial nerve, which runs through the tarsal tunnel located behind the medial malleolus, becomes compressed. The compression can lead to symptoms such as shooting pain, tingling, or numbness that radiates along the distribution of the nerve, particularly affecting the medial side of the ankle and the sole of the foot. In contrast, Achilles tendinopathy primarily affects the Achilles tendon, leading to localized pain along the back of the heel rather than the medial side of the ankle, making it less relevant to the symptoms described. Ankle sprains typically present with lateral ankle pain due to ligamentous injury and do not usually cause paresthesias in the medial ankle region. Plantar fasciitis primarily causes heel pain, particularly with the first steps in the morning or after prolonged sitting, and does not commonly result in paresthesias in the medial ankle. Thus, the characteristic symptoms of pain and paresthesias specifically align with tarsal tunnel syndrome due to the involvement of the tibial nerve and its progression through the tarsal tunnel.