Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is a painful condition that is caused by the entrapment of the posterior tibial nerve on the inside of the ankle. There are some very tight structures in this area, so there is very little room for expansion if any of these structures becomes inflamed or enlarged. This inflammation or enlargement of the nerve in this area causes the entrapment. Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as: Over-pronation (flat feet),: Diabetes, osteoarthritis at the ankle joint and rheumatoid, Ankle fractures and other similar traumas causing a misalignment, Fusing of two of the tarsal bones, Non-supportive footwear, An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, swollen tendon, ganglion, lipoma, and arthritic bone spur. Pain (often described as burning) radiating into the arch of the foot, heel and sometimes the toes.
Numbness including pins and needles may be felt in the affected area of the foot.Pain when running or when standing for long periods of time. Usually relieved by rest and often worst at night.
Tenderness to the touch of the area under the medial malleolus.

X-rays: X-rays help determine the cause for specific cases of tarsal tunnel syndrome. X-rays can be useful to determine the presence of any other structures such as cysts, arthritis, exostosis or a tarsal coalition.

Treatment

Non-Surgical Treatment
Treatment of tarsal tunnel syndrome usually begins with strategies can accomplish at home. Immobilize the area, Appropriate Footwear, Ice, Limit activities, Medications, Orthotic devices, Injection therapy, and Physical therapy.

Although most patients with Tarsal Tunnel Syndrome respond to non-surgical treatment, a small percentage of patients may require surgery. If you do not respond to non-surgical treatment, and continue to have pain, surgery will be considered.

Surgical Treatment
Both the traditional and minimally invasive surgical correction techniques are performed at the Coeur d’Alene Foot and Ankle Surgery Center. Both techniques involve a release of ligament and exploration of the tarsal canal with decompression of the posterior tibial nerve. Because the minimally invasive techniques are less traumatic, and the recovery time shorter, most patients prefer this method of correction. Each patient is unique, however, and the doctor will discuss which technique he feels best suits the patient for optimal outcome. Open or traditional surgical correction techniques require a large incision, several centimeters in length, which is made on the inside of the ankle, allowing the surgeon access to the structures for release and decompression. The incision is closed with stitches, and you are placed in a bulky bandage to protect the foot while it heals. You may be placed in a splint for certain open technique corrections. The large incision into the ankle may preclude the patient from bearing any weight on the foot immediately.