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Tarsal Tunnel Syndrome

The Condition

The tarsal tunnel is an anatomic passageway on the inside area of the ankle. It is a space where nerves, blood vessels and tendons travel from the lower leg into the foot. It is encased in a thick fibrous band of tissue called the flexor retinaculum. This structure maintains the content of the tunnel and allows for little expansion of the soft tissue. Tarsal tunnel syndrome occurs when the tibial nerve becomes compressed in the tunnel. This causes symptoms of pain, burning, tingling and numbness to the foot and ankle. A common complaint associated with this condition is heel pain, which can be mistaken for plantar fasciitis.

The Treatment

Symptoms associated with tibial nerve compression can be addressed with several methods. Topical compounded pain relief medications, oral medications, steroid injections, and physical therapy based modalities can sometimes be useful in treatment. Surgery is typically indicated for more symptomatic patients with advanced symptoms.

Frequently Asked Questions

This is a condition where the tibial nerve becomes compressed in the tarsal tunnel. It is similar in nature to carpal tunnel syndrome which occurs in the wrist.
Tarsal tunnel syndrome results in paresthesias of the foot and ankle. Paresthesias include symptoms of burning, tingling, numbness, pain, electric sensations, skin crawling and vibration sensations. Some patients may experience muscle cramping and twitching associated with the nerve compression. Diagnosis of the condition is not dependent upon the presence of all potential symptoms. Most individuals only present with several.
There are multiple causes for tarsal tunnel syndrome. The condition can be associated with decreased arch height, varicose veins, direct nerve injury, neuroma formation, metabolic diseases (such as diabetes), soft tissue masses and arthritis. In all of these conditions, the nerve becomes injured or compressed. Identifying and addressing the underlying cause will typically aid in the resolution of symptoms.
Obtaining a thorough patient history and performing a physical examination of the foot and ankle will provide your podiatrist with a good understanding of your condition. Additional tests may be ordered including an MRI, EMG/NCV (electromyography/nerve conduction velocity studies) and laboratory blood work. These tests will help to confirm the diagnosis and determine the underlying reason the condition developed.
Conservative care measures may be beneficial for some patients. You will have to work with your podiatrist to determine the best combination of treatments to alleviate your symptoms.
In many cases patients do not improve without surgical decompression of the tibial nerve. This procedure is relatively simple. An incision centered over the tibial nerve is made, the flexor retinaculum is released, and the nerve is freed of any associated restriction. Upon closure of the surgical site the flexor retinaculum is not repaired. This allows for expansion of the soft tissue at the tarsal tunnel and reduces the risk for future nerve compression.