What is Tarsal Tunnel Syndrome?
About the Tarsal Tunnel
The tarsal tunnel is located on the inside of the ankle beside the ankle bones. It’s surrounded by the flexor retinaculum, a ligament, and the posterior tibial nerve is inside the tunnel. The posterior tibial nerve is the nerve affected in tarsal tunnel syndrome.
Tarsal Tunnel Syndrome: What is it?
Tarsal tunnel syndrome is a lot like carpal tunnel syndrome, except tarsal tunnel syndrome is in the foot instead of in the wrist like carpal tunnel syndrome. Both syndromes are caused by compressed nerves. In tarsal tunnel syndrome, the posterior tibial nerve is squeezed or compressed. Compression on the posterior tibial nerve can cause symptoms to develop anywhere along the path of the nerve, which runs on the inside of the ankle into the foot.
What are the Symptoms of Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome may cause the symptoms listed below:
- A tingling or burning feeling. Some patients feel a sensation akin to an electric shock.
- Lack of feeling or numbness
- Pain. Some patients have a shooting pain.
Usually, the symptoms of tarsal tunnel syndrome are experienced on the inside of the ankle and/or the bottom of the foot. Some patients may experience symptoms in one area and others may have symptoms in many different areas. Symptoms can come on quickly and can be brought on or exaggerated by stress and overuse.
Seeking early and proper treatment is vital if you suspect tarsal tunnel syndrome. If you do not seek treatment, tarsal tunnel syndrome will progress and may eventually lead to permanent nerve damage in the foot.
What are the Causes of Tarsal Tunnel Syndrome?
Because the syndrome is caused by a compression of the nerve, anything that compresses the nerve can lead to tarsal syndrome, including:
- Flat feet, which can put stress on the nerve.
- Any outside development that can press on the nerve, including a varicose vein, a ganglion cyst, a swollen tendon, or an arthritic bone spur.
- An ankle sprain or other injury can cause swelling, which can press on the nerve and cause it to be compressed.
- Overweight people can experience pressure on the nerve, which can lead to tarsal tunnel syndrome.
- Diseases like diabetes and/or arthritis can cause inflammation to develop as well, which can cause pressure on the nerve.
How is Tarsal Tunnel Syndrome Diagnosed?
If tarsal tunnel syndrome is suspected, your podiatrist will evaluate your foot and ascertain whether or not there is any loss of feeling or numbness in the foot or other signs of tarsal tunnel syndrome. An MRI may be utilized if a mass is suspected or if initial treatment does not lessen the symptoms caused by the syndrome. In addition, special studies used to evaluate nerve problems -- electromyography and nerve conduction velocity (EMG/NCV) -- may be ordered if the condition shows no improvement with non-surgical treatment.
What is the Recommended Treatment?
There are several treatment options available for tarsal tunnel syndrome. Usually, more than one treatment option is utilized. Treatments may include:
- Rest. It may be necessary to take some off and stay off the foot while it heals. You want to avoid putting more pressure on the nerve or causing further injury.
- Ice. You can apply ice over a thin towel to the affected area for 20 minutes of each waking hour to help relieve inflammation. Never apply ice directly to the skin.
- Oral medications. Non-steroidal anti-inflammatory medications, such as ibuprofen, may be prescribed by your doctor to help lessen any inflammation or pain.
- Immobilization. While the foot and nerve heals, it may need to be immobilized with a cast.
- Physical therapy. Your podiatrist may recommend ultrasound therapy, exercises, and/or other types of physical therapy.
- Injection therapy. Injections of a local anesthetic provide pain relief, and an injected corticosteroid may be useful in treating the inflammation.
- Orthotic devices. Your podiatrist may recommend custom shoe inserts to help reduce compression on the nerve.
- Shoes. Supportive shoes are always important and a shoe change may be recommended.
- Bracing. Those suffering from flatfoot or those with severe symptoms and nerve damage may need a brace to help lessen the amount of pressure placed on the foot.
- Surgery. In some cases, Tarsal Tunnel Release surgery is the best treatment option. Your podiatrist will establish whether or not surgery is needed and will help you to choose the best procedure or procedures. The procedure chosen is often based on the cause of the condition.