WHAT IS TARSAL TUNNEL SYNDROME?
There is an important nerve that travels near the ankle on the inside (medial) part of the foot called the Tibial Nerve. This nerve courses through a series of ligaments that act like a tunnel, protecting the nerve as it passes by the ankle. Once the nerve passes by the ankle it splits into three branches coursing through the bottom of the foot and the heel. These nerves supply sensation to the skin on the heel and bottom of the foot. If the nerve becomes damage and swollen, the tunnel in which it travels may then compress the nerve. As the nerve gets squeezed it cannot function correctly. This then will procedure symptoms within the foot and heel. Tarsal tunnel syndrome is similar to a problem in the hand called carpal tunnel syndrome.
WHAT ARE THE SYMPTOMS OF TARSAL TUNNEL SYNDROME?
The symptoms of Tarsal Tunnel syndrome can range from mild numbness to severe pain. Patients may describe burning, tingling, electric shooting in the skin, numbness or pain. The symptoms will usually begin in the heel and move to the bottom of the foot and the big toe. Some will feel symptoms on the inner side of the ankle. There can be symptoms at rest and with walking. Exercise and increase activity can make the symptoms worse.
WHAT CAUSES TARSAL TUNNEL SYNDROME?
Tarsal tunnel syndrome usually effects active adults. It is rarely present in children. Nerves are very sensitive to a change in their normal environment. When a nerve is overstretched or compressed or squeezed, it cannot transfer the information to the foot and back to the brain properly. The continued damage and trauma to the nerve will result in symptoms. When it is compressed by another anatomical structure, the neurological impulses through it are restricted. This causes pain, a burning sensation, and tingling. In many causes the compression is caused by an adjacent muscle that grows too large for the area or from scar tissue. When the nerve is damaged it can become swollen and the nerve will become compressed within its tunnel.
People with exceptional flat feet can develop tarsal tunnel syndrome due to the flattened arch, causing strain on the muscles and nerves around the ankle and changes in their route slightly, producing compression on the tibial nerve.
In some cases, compression results from a cyst or mass in this area of the nerve. Systemic diseases such as rheumatoid arthritis, and diabetes also can cause tarsal tunnel syndrome.
Another common cause of tarsal tunnel syndrome is trauma to the ankle such as a fracture. When the injury heals, fibrous tissue, similar to a scar develops. If too much scar tissue forms, it can restrict movement in the tarsal tunnel and cause entrapment of the nerve.
In some patients there are over grown or damage veins that are wrapped around the nerve. When the veins become engorged after increased activity or exercise, they can strangulate the nerve. This is why some patients feel increased symptoms after exercise.
HOW IS TARSAL TUNNEL SYNDROME DIAGNOSED?
Diagnosis is simply achieved by the clinical examination and occasionally an MRI of the foot. Dr. Heath will listen to your complaints, symptoms and goals. The examination involves a hands-on analysis of the patients foot and evaluating their gait. An MRI scan of the ankle may be needed to evaluate the tarsal tunnel syndrome. Nerve conduction studies (EMGNCS) may also be ordered to evaluate the degrees of the nerve damage.
In some cases, evaluation of the lower back may be needed to rule out nerve damage in the back that may mimic tarsal tunnel syndrome.
HOW IS TARSAL TLINNEL SYNDROME TREATED?
Dr. Heath educates the early diagnosis and treatment of a tarsal tunnel syndrome are the keys to successful treatment, faster recovery and resolution of the symptoms of the tarsal tunnel syndrome.
CONSERVATIVE TREATMENT FOR TARSAL TUNNEL SYNDROME:
Conservative treatments rely on their ability to reduce the abnormal forces acting on the nerve. Then treatment is focused on the healing the nerve. This can be achieved by wearing appropriate shoe with support. A short course of non-steroidal anti-inflammatory with ice therapy over the nerve is indicated. Physical therapy may be ordered. Custom molded orthotics can be made as an important tool to slow the progression of the tarsal tunnel syndrome and help prevent recurrence after tarsal tunnel syndrome surgery. Injection therapy with cortisone may also prove effective to reduce the swelling and scar tissue around the nerve.
SURGICAL TREATMENT FOR TARSAL TUNNEL SYNDROME:
Dr. Heath will always recommend and attempt conservative treatment when appropriate. However, when a tarsal tunnel syndrome deformity becomes chronically painful, and activity is difficult, surgical repair may
IS TARSAL TUNNEL SYNDROME SURGERY PAINFUL?
Considering surgery can be intimidating. When the skin and the soft tissues are handled with care and focus, most patients experience little pain immediately after surgery and throughout the recovery period. Dr. Heath takes great care and focus on minimize the chance of post-operative pain. the goal of tarsal tunnel syndrome surgery is to relieve stress on the nerves, alleviate pain, allow a return to normal shoes, and allow a return to desired activities. Most procedures allow for immediate assisted walking and a return to work while wearing a special walking boot. Dr. Heath performs the procedures in an outpatient setting at a state of the art facility.
TARSAL TUNNLE RELEASE:
The purpose of surgery to the tarsal tunnel is to release the structures that are compressing the nerve. This will allow the nerve to move freely about the ankle without the continued pressure of the abnormal soft tissue that surround the nerve. Once the compression is removed from the nerve, it can transfer information properly and the symptoms will subside over time.
An incision is made along the inner aspect of the ankle to the level of the heel. The ligamentous structures Of the tarsal tunnel are identified and cut and released. The main branch of the tarsal tunnel nerve (tibial nerve) is identified. Any abnormal structures, ligaments, mass or veins are removed.
Further exploration of the area is performed to identify the three branches of the main nerve and their respective tunnels. The tunnels and ligaments and muscles that are constricting the nerve branches are released. The skin is then closed.
The patient is placed into a cast and sometimes crutches for a period of 3 weeks with another 3 weeks in a walking boot. Physical therapy maybe recommended to facilitate a full recovery.