What is it?
Tarsal tunnel syndrome is caused by compression of the tibial nerve on the inside of the ankle. It can result in pain ,numbness or tingling in the feet and toes.It is present in a fair number of patients with Diabetes and is often missed as part of the differential diagnosis of someone with pain in the feet.
Causes:
Tarsal tunnel syndrome is not exclusive but has a higher incidence in patients with?
- Persons with flat feet as the outward tilting of the heel that occurs with fallen arches can produce strain and compression on the nerve.
- Systemic diseases, such as Diabetes or arthritis, can cause swelling, thus compressing the nerve.
- An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. These include a ganglion cyst, swollen tendon or arthritic bone spur.
- An ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
If the nerve is not decompressed then the nerve undergoes irreversible structural damage leading to loss of sensation on the bottom of the feet.
Diagnosis
The diagnosis can be difficult in many cases and further investigations may be required. During this examination, the surgeon will position the foot and tap on the nerve to see if the symptoms can be reproduced. Compression of the nerve on the inside of the ankle will be done to see if the symptoms are replicated.
Advanced imaging studies may be ordered if a mass is suspected or if initial treatment does not reduce the symptoms. Nerve conduction studies may be required to confirm the diagnosis.Other investigations may include MRI scans or Ultrasound of the ankle to assess the integrity of the tibial nerve.
Nonsurgical Treatment
Many treatment options, often used in combination, are available to treat tarsal tunnel syndrome. These include:
- Rest,Ice,Painkillers. Staying off the foot when possible prevents further irritation of the nerve and helps in healing.Ice also helps to soothe the area and alleviate soreness and swelling. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
- Physical therapy. Ultrasound therapy, exercises and other physical therapy modalities may be prescribed to reduce symptoms.
- Injection therapy. Injections of a local anesthetic and steroid provide pain relief, and reducing the inflammation.
- Orthotic devices. Custom shoe inserts may be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve.
- Shoes. Supportive shoes may be recommended.
Surgery Treatment
In patients with severe Tarsal tunnel syndrome and in those who fail to respond to conservative measures, surgery is the best option for treating tarsal tunnel syndrome. The foot and ankle surgeon will determine if surgery is necessary and will select the appropriate procedure or procedures based on the cause of the condition.
