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Tarsal Tunnel Syndrome

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 (the flexor retinaculum) that protects and maintains the structures contained within the tunnel— arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome.

Other Popular Names

Who does it affect?

Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as:

Why does it happen?

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

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 occur 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 program.

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 may 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.

Diagnostics

The foot and ankle consultant will examine the foot to arrive at a diagnosis and determine if there is any loss of feeling. During this examination, the consultant 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.

Non-surgical Treatment

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

Surgery

Sometimes surgery is the best option for treating tarsal tunnel syndrome. The foot and ankle consultant will determine if surgery is necessary and will select the appropriate procedure or procedures based on the cause of the condition.

A 10 cm incision is made behind your ankle extending down to the arch of your foot. The ligament over the tibial nerve in the region of the tarsal tunnel is released. The nerve is followed in the foot, and the tunnels for the medial and lateral plantar nerves also are released. The calcaneal branch frequently has its own tunnel, which also is released. A long-acting anesthetic is used to help with postoperative pain, and because of this anesthetic, you likely will feel more numbness after surgery.

Post-sugery Rehabilitation

A soft, bulky dressing is applied. Two to three days following surgery, it will be removed. To control swelling, it is important to keep your foot elevated whenever possible, and moving your toes also will help decrease swelling. When you walk, you may put as much weight through your foot as comfort allows. A cane or crutches may be used at first to help decrease weight-bearing through your foot.

After the dressing is removed, you may begin range-of-motion exercises of your ankle, and an Ace wrap may be used to help control swelling in your foot. The stitches are removed two to three weeks after surgery depending on your wound healing. You may progress to full weight bearing as you feel comfortable and may use crutches or a cane for your comfort. In some cases with delayed wound healing, prolonged swelling or decreased ankle strength/range of motion, you may be sent to physical therapy.

Risks:

General risks:

As the feeling comes back to your foot, you may feel more tingling or burning sensations as normal sensation returns.

Specific risks:

Other surgical complications include injury to the small sensory nerves in the region or to the main nerve.

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