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Tarsal Tunnel Syndrome

Introduction

This is Patient Education Article – Tarsal Tunnel Syndrome. It explains the basics of the pathology including signs, symptoms and basic treatment options.

What is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is an entrapment neuropathy (pressure on nerve) of the tibial nerve as it courses through the inside aspect of the foot and ankle.

Symptoms

Pain, numbness, burning and electrical sensations may occur along the course of the nerve, which includes the inside of the ankle, heel, arch and bottom of foot. Symptoms are usually worsened with increased activity such as walking or exercise. Prolonged standing in one place may also be an aggravating factor.

Causes of Tarsal Tunnel Syndrome

There are a variety of factors that may cause tarsal tunnel syndrome. These may include repetitive stress with activities, flat feet, and excess weight. Additionally, any lesion that occupies space within the tarsal tunnel region may cause pressure on the nerve and subsequent symptoms. Examples include tendinitis, hematoma, tumor, varicose veins and lower extremity edema.

Diagnosis

The diagnosis of tarsal tunnel is made primarily by the clinical exam. A Tinel’s sign (radiating pain upon tapping the nerve) may be elicited. Temporary relief may be obtained with a diagnostic local anesthetic injection. Electrodiagnostic studies such as nerve conduction velocity (EMG/NCV) testing may also prove useful. Magnetic resonance imaging (MRI) may also help to evaluate for local pathology or space occupying lesions.

Non-Surgical Treatment

Conservative treatment for tarsal tunnel syndrome includes the use of:

  • Nonsteroidal anti-inflammatories
  • Ice
  • Physical therapy
  • Orthotic devices
  • Steroid injections
  • Cast immobilization.

Surgical Treatment

When conservative treatment is unsuccessful, surgical intervention may have a role. The surgery involves release of the tibial nerve and its branches from the surrounding tight structures along with incision of the fascial structure that forms a roof over the nerve bundle.

Postoperatively, a period of immobilization followed by protected weight-bearing and physical therapy may be prescribed. Complications of surgery may include continued nerve pain, tingling and numbness and the possibility of infection.

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