High Prevalence of Asymptomatic Anterior Tarsal Tunnel Syndrome in Toddy Tappers of South India: A Case Series of 21 Participants.

Background   Anterior tarsal tunnel syndrome (ATTS) is an uncommon entrapment neuropathy which occurs due to the compression of deep peroneal nerve under the inferior extensor retinaculum at the ankle. We observed a frequent occurrence of this syndrome in toddy palm tappers and hence, planned to study the association between the two. Materials and Methods   We studied the prevalence of isolated deep peroneal neuropathy at the ankle among the asymptomatic toddy tappers enrolled over a period of 3 months. Results   In our case series, 81% (17/21) of the study participants had ATTS of which 43% (9/21) had unilateral and 38% (8/21) had bilateral involvement. There was a strong inverse association (p < 0.001) of "duration of toddy tapping in years" with peroneal (extensor digitorum brevis) amplitudes on both the sides. Conclusion   Our study confirms "palm tree climbing" to be an occupational etiology of ATTS.