Tarsal tunnel syndrome is an extrinsic and/or intrinsic compression neuropathy of the posterior tibial nerve which travels through the tarsal tunnel. They may be a space occupying lesion, such as a ganglion cyst, a bony prominence or other etiology. The incidence of double lesions is quite rare. We report a 22-year-old female with combined talocalcaneal non-osseous coalition and a ganglion cyst over the left medial malleolar that lead to left foot tarsal tunnel syndrome. The patient was successfully treated with resection of both lesions. At 6-month follow up, she had a pain-free ankle. Numbness and range of motion improved and no residual Tinel's sign was noted.
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