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Tarsal Tunnel Syndrome

What Is It?

The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament that protects and maintains the structures contained within it – arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome.

Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve. It produces symptoms anywhere along the path of the nerve, running from the inside of the ankle into the foot.

It is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.

Symptoms

Patients with tarsal tunnel syndrome experience one or more of the following symptoms:

• Tingling

• Burning – a sensation similar to an electrical shock

• Numbness

• Pain, including shooting pain

Symptoms are typically felt on the inside of the ankle and or on the bottom of the foot. In some people, a symptom may be isolated and occurs in just one spot. In others, it may extend to the heel, arch, toes, and even the calf.

Sometimes the symptoms of the syndrome appear suddenly. Often they are brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising, or beginning a new exercise programme.

It is very important to seek early treatment if any of the symptoms of tarsal tunnel syndrome occur. If left untreated, the condition progresses, and could result in permanent nerve damage. In addition, because the symptoms of tarsal tunnel syndrome can be confused with other conditions, proper evaluation is essential so that a correct diagnosis can be made, and appropriate treatment initiated.

Causes

Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve. Examples include

• A person with flat feet, who is at risk because of the outward tilting of the heel that occurs, as “fallen” arches can produce strain and compression on the nerve.

• An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve, such as a varicose vein, swollen tendon, and arthritic bone spur.

• An injury such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in the compression.

• Systemic diseases such as diabetes or arthritis, can cause swelling, thus compressing the nerve.

Diagnosis

An orthopaedic specialist will examine the foot to diagnosis and determine if there is any loss of feeling. During this examination the specialist will position the foot, and tap on the nerve, to see if the symptoms can be reproduced. He or she will also press on the area to help determine if a small mass is present. Advanced imaging studies may be ordered if a mass is suspected or if initial treatment does not reduce the symptoms.

Non-surgical Treatment

A variety of treatment options, often used in combination, are available to treat tarsal tunnel syndrome. These include:

• Rest – Staying off the foot prevents further injury and encourages healing.

• Ice – Applying an ice pack to the affected area for 20 minutes and repeating a few times a day.

• Oral medications – This helps reduce the pain and inflammation.

• Immobilisation – Restricting movement of the foot by wearing a cast is sometimes necessary, to enable the nerve and surrounding tissue to heal.

• Physical therapy – Ultrasound therapy, exercises, and other physical therapy may be prescribed to reduce symptoms.

• Injection therapy – An injected corticosteroid may be useful in treating the inflammation and pain.

• Orthotic devices – Custom Arch Supports (shoe inserts) may be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve.

• Shoes – Supportive shoes may be recommended.

When is Surgery Needed?

Sometimes surgery is the best option for treating tarsal tunnel syndrome. An orthopaedic specialist will determine if surgery is necessary and will select the appropriate procedure or procedures based on the cause of the condition.

Wow, it’s my anniversary…a year we have been sharing this space together. I enjoy doing this column and appreciate even more the feedback and support…thanks a mil!

Your feet mirror your general health . . . cherish them!

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