Tarsal Tunnel

What is tarsal tunnel?

The tarsal tunnel is located on the inside of the ankle and is a very narrow space. It is covered with a ligament for protection and structure maintenance. The posterior tibial nerve, one of the structures, is the main focus of tarsal tunnel syndrome. 

What is tarsal tunnel syndrome?

Tarsal tunnel syndrome occurs when the posterior tibial nerve is compressed, leading to symptoms along the nerve path. Several instances can lead to this compression, such as:

• Flatfeet –  fallen arches can produce strain due to the outward tilting of the heel
• Enlarged/abnormal structures – can occupy space within the tunnel and press on the nerve. Examples of abnormal structures include ganglion cyst, swollen tendon, or an arthritic bone spur.
• Injury – may produce inflammation and swelling
• Diseases (i.e. diabetes or arthritis) – can cause swelling, thus compressing the nerve.

What are the symptoms? 

• Tingling, burning, or a sensation similar to an electrical shock
• Numbness
• Dull or shooting pain

Symptoms typically occur on the inside of the ankle or bottom of the foot. The symptoms can be in one area or can extend to other areas of the lower leg, ankle, and foot. Most often, patients experience the symptoms over time due to overuse of the foot or with the introduction of new exercise/movement routines. Occasionally the symptoms are more sudden.  As you may notice, the symptoms are very similar to those of other conditions. For that reason, early evaluation and analysis are essential to appropriate diagnosis and treatment. 

How is a diagnosis made?

Dr Amir will first examine the foot to determine if there is any numbness. He will position the foot and tap on the nerve to see if the symptoms flare-up. He will also check the foot to help determine if a small mass is present.

What are the treatment options?

Seeking treatment at early stages is of the utmost importance for tarsal tunnel syndrome. If treatment processes are not put in place, the condition can worsen or even lead to permanent nerve damage. There are several treatment options, and they are oftentimes used simultaneously, including:

• Rest – to encourage the foot to heal and stop further damage from occurring. 
• Ice – applying an ice pack to the foot in stages will help reduce swelling 
• Oral medications (ibuprofen) – to help decrease inflammation and alleviate pain.
• Cast – to restrict movement and promote healing of the nerve and tissues 
• Physical therapy – to help strengthen and reduce symptoms 
• Injection therapy – to help provide pain relief
• Orthotic devices – to help maintain the arch and limit nerve compression 
• Supportive shoes – to help provide structure and balance
• Bracing – to reduce pressure for those patients with severe pain or nerve damage 

When is surgery needed?

If a mass is suspected or initial non-surgical treatment does not work, Dr Amir may order advanced imaging studies to evaluate nerve problems. These imaging studies include electromyography and nerve conduction velocity (EMG/NCV). From there, Dr Amir will determine if surgery is necessary and will communicate which procedure is best suited.