Tarsal tunnel syndrome, right lower limb
ICD-10 G57.51 is a billable code used to indicate a diagnosis of tarsal tunnel syndrome, right lower limb.
Tarsal tunnel syndrome (TTS) is a condition characterized by the compression of the posterior tibial nerve as it passes through the tarsal tunnel, a narrow space located on the inside of the ankle. This syndrome can lead to pain, numbness, tingling, and weakness in the foot and toes, particularly affecting the right lower limb in this case. The symptoms often worsen with activity and may be relieved by rest. TTS can result from various factors, including repetitive stress, trauma, systemic diseases such as diabetes, or anatomical abnormalities. Diagnosis typically involves a thorough clinical examination, patient history, and may include nerve conduction studies to assess the function of the posterior tibial nerve. Treatment options range from conservative measures, such as orthotics and physical therapy, to surgical intervention in severe cases. Accurate coding is essential for proper reimbursement and to reflect the patient's condition in the medical record.
Detailed neurological examination findings, results of nerve conduction studies, and treatment plans.
Patients presenting with foot pain, numbness, or tingling, especially after physical activity.
Ensure that all neurological assessments are documented to support the diagnosis.
Surgical notes if applicable, imaging studies, and conservative treatment documentation.
Patients with chronic ankle pain or those who have undergone surgical intervention for TTS.
Document any anatomical abnormalities or previous injuries that may contribute to the condition.
Used to confirm diagnosis of TTS.
Document the specific nerves tested and results.
Neurologists should ensure comprehensive documentation of findings.
Common symptoms include pain, tingling, and numbness in the foot, particularly along the distribution of the posterior tibial nerve.
