What is tarsal tunnel syndrome?
Tarsal tunnel syndrome is the medical term for injury or compression of the posterior tibial nerve as it passes through the tarsal tunnel, a small cavity that lies on the inside of the ankle.The tarsal tunnel is covered by the flexor retinaculum a thick ligament that protects the soft tissues that travel through the tunnel including arteries, tendons and nerves including the posterior tibial nerve. Tarsal tunnel syndrome occurs when the space through the tunnel decreases and compresses the nerve passing through.
Why & when does the tarsal tunnel syndrome happen?
Tarsal tunnel syndromeeis a relatively common condition and effects people of all ages it is most often seen in people who have hypermobile or weak ankles and suffer from repetitive ankle sprains. It is also commonly seen in people whose arches have fallen and have very flat feet. Either through one single traumatic compression (an ankle sprain) or repetitive compression the nerve can become damaged and inflamed. Cysts, ganglions and varicose veins can also compromise the space in the tunnel and compress the nerve as can local swelling from arthritis and diabetes.
What does tarsal tunnel syndrome feel like?
Tarsal tunnel syndrome can cause a very intense sharp pain, tingling and burning around the inside of the ankle and into the sole of the foot. The pain will be accompanied by numbness, local swelling and possible bruising and will be incredibly tender to touch. Pain levels will be aggravated by any side to side foot movements and in particular walking and running on uneven surfaces. Symptoms normally occur suddenly after aggravating physical activities.
How is tarsal tunnel syndrome diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you and tapping the posterior tibial nerve. Your doctor will most likely order an X-ray or further imaging of the foot to rule out the presence of any cysts, soft tissue masses or ganglions from the tunnel. If the syndrome is not responding to conservative treatment then an electromyography (an EMG) may be ordered to further evaluate the nerve.
What treatment options are available for tarsal tunnel syndrome?
Early diagnosis and treatment is very important with tarsal tunnel syndrome as if left untreated the nerve compression can lead to permanent nerve damage.Conservative treatment options for tarsal tunnel syndrome include shoe modifications, opting for high topped shoes that support and reinforce the weakened, instable ankle. Orthotics and arch inserts can be used to support and cushion the arch preventing further compression of the tunnel. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling there is also the option of corticosteroid injections to reduce persistent inflammation and pain. Occasionally a brace or strapping will be used to stabilise the foot and ankle and prevent further injury. Your doctor may also refer you to a podiatrist/chiropodist or physiotherapist who may use ultrasound or manual therapy to reduce pain levels.
Doctors will normally only recommend surgical intervention when conservative treatment has failed, however due to the risk of permanent nerve damage surgery is often the best option. You will be referred to a specialist ankle and foot orthopaedic surgeon who will recommend the type of surgery based on your health, activity level and the severity and extent of your condition. The recovery and results you see after surgery will vary, depending on the type of procedure performed.