What is tarsal tunnel syndrome?
The tarsal tunnel refers to the canal formed between the medial malleolus (part of the ankle bone, this is the bump on the inside of the ankle) and the flexor retinaculum (a band of ligaments that stretches across the foot). Inside the tarsal tunnel are the nerves, arteries, and tendons that provide movement and flexibility to the foot.
One of the nerves in the tarsal tunnel is the tibial nerve, which provides sensation to the bottom of the foot. When this nerve is compressed, the resulting condition is called tarsal tunnel syndrome (TTS). Tarsal tunnel syndrome has also been called posterior tibial neuralgia.
What are the causes of Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as:
- A person with flat feet is at risk for developing tarsal tunnel syndrome, because the outward tilting of the heel that occurs with “fallen” arches can produce strain and compression on the nerve.
- An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon, and arthritic bone spur.
- An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
- Systemic diseases such as diabetes or arthritis can cause swelling, thus compressing the nerve.
What are the symptoms of Tarsal Tunnel Syndrome?
- Shooting pain in the foot
- Tingling or burning sensation
Symptoms are typically felt on the inside of the ankle and/or on the bottom of the foot. In some people, a symptom may be isolated and occur in just one spot. In others, it may extend to the heel, arch, toes, and even the calf.
Sometimes, the symptoms of the syndrome appear suddenly. Often, they are brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising, or beginning a new exercise program.
How is Tarsal Tunnel Syndrome Diagnosed?
A comprehensive clinical exam
Complete medical history
Imaging (X-rays, CT, or MRI scans)
Diagnosis is necessary to determine the severity of the condition, so the appropriate treatment plan, including a surgical option, can be considered.
What is the treatment for Tarsal Tunnel Syndrome?
Possible treatment options may include anti-inflammatory medications or steroid injections into the nerves in the tarsal tunnel to relieve pressure and swelling. Orthosis (e.g., braces, splints, orthotic devices) may be recommended to reduce pressure on the foot and limit movement that could cause compression on the nerve.
Depending on the severity of the condition, one of several surgical options may be recommended, including tarsal tunnel release.
How is the surgery performed for Tarsal Tunnel Release?
In some cases, your doctor may recommend a surgery called the tarsal tunnel release. During this procedure, your surgeon will make an incision from behind your ankle down to the arch of your foot. They will release the ligament, relieving the nerve.
A minimally invasive surgery is also used when possible, in which much smaller incisions are made inside your ankle. The surgeon uses tiny instruments to stretch out the ligament. Because there’s less trauma sustained by the tissues, the risk of complications and recovery time are both reduced.
What is the recovery like after Tarsal Tunnel Release Surgery?
Recovery after Tarsal Tunnel Surgery is unique to each patient but generally, you will be advised to keep the dressing on your foot until you return to your doctor for follow up, and to avoid getting the stitches wet. Most patients are given a boot to wear to protect their incision. Your stitches will usually be removed 10 days after surgery, at which time you will switch to a supportive walking boot. Most patients have a very good outcome.