Tarsal Tunnel Syndrome

What is it? 

Tarsal Tunnel Syndrome is caused by compression to the tibial nerve at the level of the inside ankle/foot. It is similar to carpal tunnel syndrome in the wrist. The nerve can become damaged if the condition is not diagnosed early. Causes include: 

  • Flat Foot type
  • Space occupying lesion: varicose veins, ganglion cyst, swollen tendon, bone spurs, tumor
  • History of trauma: ankle sprains
  • Disk Herniation at L4-S3
  • Systemic Disease: Diabetes, seropositive/seronegative arthropathies

Symptoms: 

Symptoms include tingling, burning, numbness, or shooting pain that radiates along the course of the nerve. Discomfort can be along the inside of the ankle or bottom of the foot. Commonly patients present with heel pain and maybe misdiagnosed with plantar fasciitis. The pain is exacerbated by overuse of the foot.   

Diagnosis: 

Palpation along the tibial nerve may cause radiating pain up/down the course of the nerve, reproducing the patients’ symptoms. Advanced imaging should be done if an underlying tumor is suspected, and conservative therapy has not improved the symptoms. Electromyography/nerve conduction velocity (EMG/NCV) tests can be ordered to detect nerve dysfunction.

Treatment:    

Once the diagnosis  is made, conservative therapy begins: 

  • Rest/Ice Massage
  • Avoid barefoot walking
  • Take a short course of non-steroidal anti-inflammatory drugs (NSAIDs)
  • Immobilization
  • Shoe gear modifications/Custom Orthoses/Bracing: Prevent excessive eversion
  • Physical Therapy
  • Local injection of a corticosteroid

 

When conservative therapy fails, and patients continue to experience pain, surgical management becomes a viable option:

  • Objective: Relieve pressure on the tibial nerve and its branches:
    • Tarsal Tunnel Nerve Release
    • Remove occupying space lesions

 

Patients experiencing any of the above -described symptoms should seek diagnosis and treatment from a podiatrist at Foot and Ankle Specialists of the Mid-Atlantic. 

 

References: 

https://www.podiatrytoday.com/article/3337

https://www.acfas.org/footankleinfo/tarsal-tunnel-syndrome.htm

https://www.healthline.com/health/tarsal-tunnel-syndrome#diagnosis 

https://www.footankleinstitute.com/conditions/nerve-pain/tarsal-tunnel-syndrome

https://www.foot-pain-explored.com/tarsal-tunnel-syndrome.html

 

 

Dr. Brittany Brower  works in our Raleigh, NC and Holly Springs, NC offices for your convenience.

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