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What is Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome is a painful condition in which the large nerve leaving your leg is injured in the area behind your ankle as it enters the foot.
The largest nerves in the foot run from the inner side of the ankle down to the arch. This is called the posterior tibial nerve. This nerve goes through the tarsal canal which has a combination of tendons, veins and arteries. Often this area gets compressed or damaged leading to pain to the arch and heel of the foot called Tarsal Tunnel Syndrome (TTS).
Lower Extremity Nerves
Your spine has multiple levels and each level gives off a nerve branch which goes to various parts of your body. The lower extremity is basically controlled by the lumbar and sacral nerve roots exiting the spine, traveling through the pelvis and down the leg to the foot.
Neves are obviously sensitive tissue and respond swiftly with injury. The nerve can be injured in several places with resultant pain. In the back the nerve can be injured by disc disease or spinal arthritis causing pinching of the nerve in the back.
As the nerve leaves the pelvis tight muscles or muscles in spasm can also pinch the nerve as it begins to travel down the leg. A common area of nerve injury is just behind the ankle bone where the nerve begins to transform into the smaller tighter bundle of nerves commonly found in the foot. As the nerve turns and changes position it can become crimped and damaged. Also, the position of the foot can have influence as excessive pronation will cause the foot to flatten and as a result the nerve will become stretched and pinched as its canal becomes tight.
What Are The Causes of Tarsal Tunnel Syndrome?
People who have flat feet are susceptible to developing tarsal tunnel syndrome. The collapsed arch compresses the inner side of the ankle where the nerve runs, causing it to get impinged.
People with lots of leg swelling, mostly as a result of various veins can get symptoms. The large veins run parallel to the Tibial nerve and when these veins get inflamed, they will compress against the nerve.
Nerve injuries can also occur in patients who are athletic or professional athletes. Direct trauma or even ankle sprains, as can happen in soccer or basketball sports is a common cause of tarsal tunnel syndrome. In athletes it is often a result of overuse.
Soft tissue masses can grow in the tarsal canal leading to pressure on the nerve. Removing these masses helps eliminate the symptoms of tarsal tunnel syndrome.
What Are The Signs And Symptoms of Tarsal Tunnel Syndrome?
Symptoms often start off as numbness and tingling from the heel that can often radiate down to the toes. Often people experience it as pain in the morning when initiating walking, which can often be confused with plantar fasciitis. As time goes on the pain can progress to a sharp shooting pain and often weakness in the foot and ankle. Majority of the symptoms are amplified with increased walking. Pain can also continue even with rest.
- Burning sensation
- Weakness in your intrinsic foot muscles
- Numbness to the arch and the toes
- Tingling feeling at rest
What Are The Risk Factors of Tarsal Tunnel Syndrome?
- Flat Feet
- Leg Swelling
- Athletes especially in sports with recurrent impact along with twisting such as basketball, soccer, volleyball, etc.
How is Tarsal Tunnel Syndrome Diagnosed?
An accurate clinical diagnosis is important to diagnose tarsal tunnel syndrome as the initial symptoms can be similar to plantar fascia pain. Often it is miss diagnosed and patients continue to have a lack of improvement with treatments.
Clinically a patient will often elicit a positive Tinel’s signs which is a shooting pain that is positively produced by compression of the tibial nerve along the medial aspect of the ankle.
To confirm a diagnosis – nerve conduction velocity (NCV) and Electromyogram (EMG) testing needs to be performed. The testing should be performed by a professional Neurologist for the most accurate readings. These tests determine the conduction along the nerve and the muscles they innervate and any discrepancies along the nerve will suggest the source of the nerve damage.
MRI can be used to diagnose. In an MRI we are looking for any soft tissues in the tarsal canal that can be impinging on the Tibial nerve, as well as any muscle loss in the foot, which nerve damage can cause.
What Are Possible Treatments For Tarsal Tunnel Syndrome?
Patients with flat feet and their collapsing arches, which are impinging the nerve, can get great relief by changing into supportive athletic shoe gear along with the use of a custom orthotics. Custom orthotics provide the arch the foot needs and elevates the pressure of the nerve.
Compression with custom braces or compression socks can reduce the swelling along the veins and reduce motion at the ankle. Braces reduce movement of the nerve and can allow it to heal.
Topical compounded medicine has been shown to provide relief in 60% of patients.
Steroid injection on the nerve can reduce the inflammation around the nerve and provide relief. Injections should always be performed under ultrasound guidance for accuracy and safety.
Physical therapy can improve mobility and ultrasound therapy can help reduce symptoms.
If all conservative treatments fail then surgery is the next best treatment option.
The purpose of Tarsal Tunnel surgery is to reduce the compression of the nerve all the way from the ankle down to the heel of the foot. Recovery from surgery can take up to two months. Early range of motion and physical therapy is imperative to prevent stiffness and scarring of surgery which can delay recovery.
Should you have a suspected nerve injury or an injury that is not responding to mechanical treatment, let the Doctors of the Weil Foot & Ankle Institute help find the cause and provide relief.
Are There Preventative Steps or Measures To Avoid Tarsal Tunnel Syndrome?
Are There Other Related Conditions To Tarsal Tunnel Syndrome?
There are several other causes of heel pain, including but not limited to Plantar Fasciitis, Stress Fractures, and Achilles Tendinitis.
Key Takeaways About Tarsal Tunnel Syndrome
- Pain isn’t normal.
- Treatment is more effective with an early Diagnosis
- Tarsal Tunnel Syndrome is easily missed and therefore mis-treated unless a Podiatrist completes a full evaluation.
- Treatment is available – we have all the tools to get you feeling better at Weil Foot & Ankle Institute
Meet Weil Foot & Ankle Institute
By: Weil Foot & Ankle Institute, Published: May 20th, 2022
Review By: Lowell Weil Jr., DPM – Aug 8th, 2023