by Boyd W. Haynes III, MD
Some conditions that I treat in my orthopaedic practice are very common. I can’t tell you how many ankle sprains, torn menisci and torn ACLs I have seen. However, there are some conditions that I rarely, if ever, see. Tarsal Tunnel Syndrome is caused when the posterior tibial nerve is compressed within its channel, located next to to the ankle bone. Although it can be caused by an ankle injury, or by diabetes, and may be exacerbated by arthritis, flat footedness varicose veins, ganglion cysts, swollen tendons, and arthritic bone spurs, it is rarely seen. It is often misdiagnosed as plantar fasciitis, a stress fracture or peripheral neuropathy.
Symptoms of this condition can occur suddenly or develop over time and include:
- A burning or tingling sensation
- Numbness
- Pain in the bottom of the foot, ankle, heel, toes, or calf muscle
- It can also be described as the “pins and needles” feeling you get when your foot “falls asleep”
These symptoms may begin or worsen when participating in activities such as standing, walking, or exercising. It happens to women and men in equal numbers.
I diagnose Tarsal tunnel syndrome with a physical examination of the effected foot, by pressing on the nerve and feeling the foot for a mass. A patient’s feeling of pain or tingling being inflicted by the pressing on the nerve (Tinel’s sign), points to the cause being tarsal tunnel syndrome. I can also order tests such as electromyography (EMG) and magnetic resonance imaging (MRI) which can provide more information as to the physical condition of muscles, nerves, and tissues.
Non-operative treatments for tarsal tunnel syndrome include icing, resting, and over-the-counter pain relievers, anti-inflammatory medications and nerve pain medications. If other treatment options do not produce results, corticosteroids can be injected into the area to reduce pain and swelling. I may also recommend Orthotic devices, braces or immobilization casts. Orthotic devices are custom shoe inserts that can reduce the compression of the posterior tibial nerve, while a cast takes pressure off while allowing the nerve to heal.
If other methods prove ineffective, one surgical option is a procedure known as tarsal tunnel release, in which the surgeon cuts the ligament constricting the nerve. If the posterior tibial nerve is being compressed by surrounding cysts or masses, I may remove them. After surgery, the patient will be sent to a physical therapist that will help them to strengthen the foot and ankle, and increase the flexibility of the toe, ankle, and foot.
Complications can include infection, nerve damage, or incomplete resolution of symptoms.
Depending on the cause of the condition, tarsal tunnel syndrome may not be preventable. However, if left untreated, tarsal tunnel syndrome continues to worsen and may even permanently damage the nerve.