Tackling Tarsal Tunnel Syndrome

by Kevin Smith Author

Tarsal tunnel is a relatively rare and painful condition in the foot and ankle. It is typically a problem for athletes, but anyone can develop this syndrome. Fortunately, an orthopedic foot and ankle doctor in The Woodlands, TX, can successfully diagnose and treat tarsal tunnel syndrome, often without surgery.

What It Is

The tarsal tunnel lies between the medial malleolus (part of the ankle bone) and the flexor retinaculum (a band of ligaments that stretches across the foot). This area contains nerves, arteries, veins, and tendons necessary to move the foot.

Tarsal tunnel syndrome happens when the posterior tibial nerve in the tarsal tunnel is compressed and inflamed.

Causes

Common causes of this syndrome include ankle sprain or similar injury; swelling caused by diseases like arthritis and diabetes; an abnormally large structure like a varicose vein, ganglion cyst, bone spur, or swollen tendon near the tarsal tunnel; fusion of two tarsal bones (talonavicular coalition); and flat feet. Another possible cause is overpronation, when your foot often rolls inward while you walk or run. If this is the cause, tarsal tunnel syndrome may affect both feet at the same time.

Symptoms

The most common symptom is shooting pain on the inside of the ankle and/or sole of the foot. Pain may also be present in the toes and/or inside of the calf. Other symptoms may include a tingling or burning sensation and numbness. Sometimes symptoms occur in only one location; other times, they are experienced in multiple places.

Symptoms may develop suddenly. This syndrome can be aggravated by activities like prolonged standing or walking that the foot is not used to. The pain often feels worst when standing or running for prolonged periods and at night.

Diagnosis

These symptoms can make diagnosis difficult in some cases, so you should always consult a physician rather than attempt to self-diagnose tarsal tunnel syndrome. In particular, this syndrome can be mistaken for plantar fasciitis, which causes pain in similar areas but rarely includes numbness or tingling.

During diagnosis, the physician will tap on the posterior tibial nerve to see if the pain really originates from that nerve (tinels test) and press on the area to see if a small mass could be the cause of compression. Physicians may also use imaging like X-ray and/or electrical testing like EMG.

Treatment

Treatment is crucial for tarsal tunnel syndrome. Left untreated, it can result in permanent nerve damage.

The first stage of treatment involves resting and treating the acute pain and inflammation until it fades enough to start physical therapy. Anti-inflammatory medications may be prescribed to reduce swelling and pain.

Physical therapy includes ultrasound therapy and exercise that stretch and strengthen the area.

Your physician may also recommend orthotic devices. These external devices support or modify the function of legs and feet. Orthotics relieve pressure on the foot and limit movement that could cause more nerve compression. Depending on the severity of your case, orthotic devices range from discrete shoe inserts to heavy-duty braces and boots.

If these methods don't work well enough, your physician may recommend injections of cortisone and/or steroids to boost the healing process.

Surgery

If non-invasive treatments don't help for several weeks or months, surgery may be recommended. This surgery creates more space for the nerve to decompress, which relieves pressure on the nerve and reduces pain.

Most foot surgery can be done with local anesthesia to numb the foot and mild sedation. Recovery from this surgery can range from a couple weeks to a few months.

If you are experiencing symptoms of tarsal tunnel syndrome, visit an orthopedic foot and ankle doctor in The Woodlands, TX.