Soleal Sling Syndrome: A Narrative Review

Soleal sling syndrome is a rare cause of lower extremity neuropathy due to compression of the proximal tibial nerve under the fibromuscular arch of the soleus muscle. It presents with plantar numbness/paresthesias, calf pain, and tenderness over the proximal calf. Chronic compression can lead to toe flexor weakness. This study reviews the clinical presentation, diagnostic workup, and treatment options for soleal sling syndrome. A query of the PubMed database up until August 30, 2022, was conducted to gather relevant clinical, anatomic, and radiographic findings. The literature review identified key features of soleal sling syndrome, highlighting the importance of considering it in patients with calf pain/tenderness and plantar foot neurosensory changes. Diagnosis typically relies on history and physical examination, often with a positive Tinel's sign, though imaging modalities show inconsistent utility. Soleal sling syndrome is underrecognized and overlaps with other syndromes. Radiological imaging modalities can rule out secondary causes of proximal tibial nerve compression but lack consistency for diagnosing idiopathic cases. Surgical decompression of the nerve, via a medial or posterior approach, is the definitive treatment for all causes of tibial nerve compression.