Tarsal Tunnel Syndrome
What is Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome is a condition that arises when the posterior tibial nerve is flattened. This is a large nerve that goes down the back of your leg at the side, past the ankle bone (medial malleolus) on the inside of the foot and down to underneath the foot. This is where the nerve delivers feeling to the skin and the muscles in the foot.
When the nerve is moving down the leg, before it reaches the foot it passes a region called the tarsal tunnel. The top part of the tunnel is made of a chunky ligament, known as the flexor retinaculum. The tarsal tunnel also comprises of 3 tendons, a main artery and its veins.
People who suffer from tarsal tunnel syndrome often complain of numbness on the outside part of the foot at the bottom and pain. This pain can feel like a throbbing, prickly, achy, pins and needles kind of sensation. Sometimes it can affect the toes which is a similar symptom to a neuroma.
Tarsal Tunnel Syndrome symptoms
Tarsal tunnel syndrome is more common in adults whom are very active but it can also happen in children. Some of the main symptoms are:
*Shooting pain that worsens as the day goes on
*Numbness, burning and tingling underneath the foot
*Cold and hot feeling in the feet
*Pain in the foot when driving
*An electric shock kind of feeling
These symptoms can occur out of the blue, usually from overuse. This could be from walking, running and standing for too long. The inside of the foot and underneath the foot are where the symptoms are usually felt. Some people feel them through the arch, toes, calf and heel. This is one of those conditions that is hard to diagnose.
Causes of Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is caused when the posterior tibial nerve is trapped or squashed. The heel and ankle area is very complicated. It is where the nerves, ligaments, muscles, tendons and bones enter the foot. The smallest of change in that area can cause a lot of problems.
As the posterior tibial nerve is the biggest nerve in the foot, if for any reason there is inflammation there, this large nerve will be the first one to be squashed. When this happens then the mentioned symptoms come about. Things like varicose veins, abnormal biomechanics, bone spurs and injury can all contribute to this.
Diagnosing Tarsal Tunnel Syndrome
People who are more likely to develop tarsal tunnel syndrome are adults over 30 years of age, diabetics, those who suffer from back pain, arthritis, had an ankle injury or have abnormal foot mechanics.
If you think you might have tarsal tunnel syndrome then visit a podiatrist who will examine your foot and check for sensation underneath the foot. The doctor may carry out the Tinel’s sign test. This is when the doctor taps on the nerve to see if there is an electric shock or shooting kind of sensation up the leg or in the foot.
Treatments for Tarsal Tunnel Syndrome
The treatment suitable for you will depend on the cause. The aim is to reduce pressure on the nerve as well as reduce swelling and pain. Some of the treatments are:
*Taking anti-inflammatory medication like ibuprofen
*Wearing shoes that fit properly
*Taking vitamin B supplements
*Corticosteroid injection
*Using orthotics and shoe inserts
*Carrying out strengthening exercises for the surrounding area
*Getting plenty of rest and weight off the foot
Surgery may be required and should be carried out by a professional. This procedure involves an incision being made below and behind the inside of the ankle. Where the flexor retinaculum is cut to allow the nerve to expand. If a mass is found then that can also be removed. Once surgery is completed, the ankle joint is immobilised and the use of crutches for 2 weeks will be needed. The foot should be kept raised to help reduce swelling. Once the nerve have been injured they recover very slowly and can take up to a year to heal.
If it is a severe case of tarsal syndrome then there could be permanent damage to the nerve especially in people who suffer from diabetes. Wounds on diabetics may not heal up properly either. Most people experience no problems but with all surgical procedures, there is always a risk of infection and excessive bleeding. That said, only around 13% of patients suffer from complications after surgery.