What is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is an entrapment neuropathy (pressure on nerve) of the tibial nerve as it courses through the inside aspect of the foot and ankle.

Common Symtpoms

Tarsal Tunnel Syndrome usually causes a vague pain in the sole of the foot (below), that most patients describe as a burning, electrical or tingling type pain. There may be pain to touch along the course of the nerve as well (below).

Symptoms are usually worsened with increased activity such as walking or exercise. Prolonged standing in one place may also be an aggravating factor. A common symptom is nocturnal (night-time) burning pain causing the patient to awaken and results in the patient hanging the leg over the edge of the bed and shaking it, massaging the foot, or walking to gain relief.

Not uncommonly, there is tenderness over the nerve at the tarsal tunnel, and/or the medial aspect of the foot. Good recovery should not be expected with the presence of obvious motor weakness and muscle atrophy.

What Causes Tarsal Tunnel Syndrome?

There are a variety of factors that may cause tarsal tunnel syndrome. These may include repetitive stress with activities, flat feet, and excess weight.

Additionally, any lesion that occupies space within the tarsal tunnel region may cause pressure on the nerve and subsequent symptoms. Dr. Grisanti also evaluates for joint fixation or sometimes called a hypomobile joint.

Restriction or locking of the tarsal bones is many times an overlooked cause of tarsal tunnel syndrome. Other causes may include tendonitis, hematoma and tumors.

Diagnosis

The diagnosis of Tarsal Tunnel Syndrome begins with a complete history and physical examination. A Tinel's Sign may be present. This is a tingling sensation that shoots electric shocks into the foot when the nerve is tapped at the level of the irritation. Dr. Grisanti will evaluate the tarsal joint function and determine if a hypomobile joint exist.

Electrodiagnostic studies such as nerve conduction velocity (EMG/NCV) testing may also prove useful. Magnetic resonance imaging (MRI) may also help to evaluate for local pathology or space occupying lesions.

If more information is needed to make the diagnosis a nerve conduction velocity (NCV) may be suggested by Dr. Grisanti. This test measures how fast the nerve impulses travel along a nerve. If the test shows that the impulses are traveling slowly across the ankle, this may confirm a diagnosis of Tarsal Tunnel Syndrome.

Effective Treatments

Treatment for this condition is varied - depending on what may be contributing to the pressure on the nerve. Dr. Grisanti may perform joint mobilization to the tarsal joints which may be "locked" causing pressure on the nerve.

Anti-inflammatory medications and rest may be suggested to control the symptoms initially. If the condition is being aggravated by abnormal position of the foot, then orthotics may be suggested to relieve the stretching of the nerve. A cortisone injection may give temporary relief of symptoms.

Is Surgery Necessary?

If the symptoms fail to respond to conservative treatments, surgery to relieve the pressure on the Posterior Tibial Nerve may be suggested.

Surgery involves making a small incision behind the ankle, along the course of the Posterior Tibial Nerve. The nerve is released by cutting the Flexor Retinaculum and following the nerve into the foot, making sure the nerve is free of pressure throughout its course.

How Long Will It Take To Recovery From Surgery?

You should expect some pain following surgery as well as swelling. Especially for the first 48 hours you should keep your leg elevated and occasional ice placed over the area of surgery (about 20 minutes per hour).

Surgical cuts are made through the skin so a scar is expected. Surgical cuts are not only made through skin, but through other layers of tissue as well, a scar may form within your foot and lead to adhesions.

Typically you can get back into a supportive tennis shoe in 3-5 weeks following healing of the wound and stitches are removed. You may use crutches, a walker, or wheelchair to help you keep weight off of this foot if needed for post-operative pain.

Healing time is influenced by many factors including your nutrition, circulation, and other medical conditions. If you are a smoker you can expect to take longer to heal. If you have a history of blood clots you should let your surgeon know.

Any time surgery is done around a nerve the patient may experience a variety of feelings following surgery for several months, including some tingling, burning, and phantom pains.

Reviewed and submitted on February 29, 2005