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Tarsal Tunnel Syndrome

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  • What is Tarsal Tunnel Syndrome?

    Tarsal tunnel syndrome is a condition in which compression of the posterior tibial nerve, located within the tarsal tunnel on the inside of the ankle, causes pain, tingling, numbness or weakness in the ankle and foot.  More severe cases of the condition can result in permanent nerve damage.  The causes and effects of tarsal tunnel syndrome on the ankle and foot are similar to those of carpal tunnel syndrome on the wrist and hand.

    What causes Tarsal Tunnel Syndrome?

    Tarsal tunnel syndrome is caused by a compression of the posterior tibial nerve, which travels from the back of the leg, through the inside of the ankle, and into the foot within a narrow space called the tarsal tunnel.  The tarsal tunnel is covered by a thick ligament that protects the nerves, arteries, veins and tendons that run through the space.  Anything that causes swelling in this area can cause compression of the nerve.  This includes ankle sprains, or other injuries that may cause swelling in the area, systemic diseases such as rheumatoid arthritis, gout or diabetes, or any structure that is enlarged in the area of the tarsal tunnel that may cause nerve compression, such as a bone spur, scar tissue, ganglion cyst, enlarged muscle or varicose vein.  In some cases, individuals with flat feet will suffer from compression of nerves in the tarsal tunnel.  The condition can also arise due to overuse, such as excessive walking, running, exercising, or standing.

    What are the symptoms of Tarsal Tunnel Syndrome?

    The primary symptoms of tarsal tunnel syndrome include pain, tingling, numbness, burning or weakness felt on the inside of the ankle or the bottom of the foot.  The pain may feel like an electrical shock or a quick shooting pain.  Symptoms may also be felt anywhere along the path of the posterior tibial nerve, including the lower calf, heel, arch and portions of the toes.  Symptoms often increase as the day goes on and may improve with rest, massage or elevation.  The symptoms can occur suddenly due to an injury or can develop more gradually.

    How is Tarsal Tunnel Syndrome diagnosed?

    A medical professional in New York will take a complete medical history and will ask questions related to when the symptoms began, what types of activities or movements increase or decrease symptoms, what type of activities are regularly engaged in, and what the relative severity of the symptoms is.  A physical exam will include checking for numbness, weakness, tenderness or pain in certain areas of the ankle and foot, tapping directly on the posterior tibial nerve to see if it causes symptoms, and feeling for any type of growth or inflammation in the area of the tarsal tunnel.  Other tests include x-rays to rule out other causes of symptoms, as well as tests to check the condition of the nerves, including electromyography and nerve conduction velocity tests.

    When should I seek care for Tarsal Tunnel Syndrome?

    If you have pain, tingling, numbness or weakness in your ankle or foot that does not improve with a short period of rest, avoidance of certain activities, application of ice and taking nonsteroidal anti-inflammatory medications, you should seek medical advice.  If the symptoms increase or become severe, or you experience numbness or weakness that impedes regular activities, you should seek prompt medical attention.  Failure to treat tarsal tunnel syndrome can lead to permanent nerve damage.

    What will the treatment for Tarsal Tunnel Syndrome consist of?

    Initial treatment for tarsal tunnel syndrome includes resting or immobilizing the foot (with a brace or cast) to allow healing of the nerve, applying ice to the area to reduce inflammation, and taking nonsteroidal anti-inflammatory medications to reduce inflammation and pain.  Once the primary symptoms have diminished, physical therapy, including stretching and strengthening exercises, ultrasound, heat therapy and other modalities are often recommended.  Corticosteroid injections can reduce inflammation and may be combined with an anesthetic to alleviate pain.  If the condition is caused by the structure of the foot, orthotics or supportive shoes may be recommended to reduce pressure on the nerve.  In some cases, surgery may be required to alleviate the condition and when performed, will be followed by a rehabilitation program.

    Which muscle groups/joints are commonly affected by Tarsal Tunnel Syndrome?

    Tarsal tunnel syndrome results from compression of the posterior tibial nerve which runs from the lower leg through the ankle and into the foot.  Most symptoms are felt on the inside of the ankle and the bottom of the foot.

    What type of results should I expect from the treatment of Tarsal Tunnel Syndrome?

    Most treatments aimed at reducing the source of compression and inflammation will improve the symptoms associated with tarsal tunnel syndrome.  If a medical condition or structural growth is contributing to the condition, symptoms may improve but not completely go away.  Treating the cause of compression on the nerve is important in avoiding permanent nerve damage.  Surgery is often successful at alleviating symptoms of this condition.