What is Tarsal Tunnel Syndrome?
Tarsal Tunnel Syndrome is the compression of the posterior tibial nerve, and the symptoms can occur at any point along the nerve’s pathway, from the ankle to the foot.
The tarsal tunnel is an anatomical bony canal formed between the prominent inner part of the ankle and the tendons and flexor muscles of the foot. Inside this canal, in addition to the tendons, there are arteries and nerves that distribute to the foot. The tibial nerve, which is responsible for sensory innervation of the sole through its branches, runs through this tunnel. When this nerve is compressed, the resulting condition is known as Tarsal Tunnel Syndrome or posterior tibial neuralgia.
What are the causes of tarsal tunnel syndrome?
Tarsal Tunnel Syndrome is caused by anything that compresses the posterior tibial nerve, with the most frequent causes being:
- • Foot and ankle deformities (such as overpronation, foot valgus, and flatfoot).
- • Varicose veins, ganglia, tendonitis, or arthritic changes in the bones.
- • Ankle injuries.
- • Systemic diseases such as diabetes or arthritis.
What are the symptoms of tarsal tunnel syndrome?
The most common symptoms experienced by patients with Tarsal Tunnel Syndrome include a burning or electric shock-like sensation, numbness, and pain. These are usually felt on the inner side of the ankle or the lower part of the leg, but in some cases, they can extend to the heel, arch of the foot, or toes. The pain is present while standing and walking, worsens after prolonged standing, and is relieved by rest.
How is tarsal tunnel syndrome diagnosed?
- A detailed medical history.
- Thorough neurological examination with palpation.
- Blood tests are indicated if a systemic disease is suspected.
- Radiological examination of the area (plain X-rays, CT scan, and MRI) is performed if a palpable mass is detected or if initial treatment does not yield results.
- Electromyography and measurement of motor and sensory conduction velocity of the tibial nerve if there is no improvement with conservative treatment.
What is the treatment for tarsal tunnel syndrome?
Conservative Treatment:
Conservative management involves modifying activities, rest, and the use of special aids such as orthotic insoles and a brace for a period of 6 to 12 weeks. Additionally, physical therapy and pharmacological treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce symptoms.
In certain cases, injection therapy with local anesthetics and corticosteroids is chosen.
If conservative treatment does not achieve the desired results, surgical release of the nerve within the tarsal tunnel is required.
Surgical Treatment:
In cases where the etiology of the syndrome is a fracture in the area, trauma that has led to post-traumatic entrapment neuritis, ganglion, or an intraneural tumor, surgical intervention is recommended. Surgical opening of the tarsal tunnel results in nerve decompression and the removal of any pressure factors acting on it.
The procedure is relatively simple, and the patient does not need to be hospitalized since minimally invasive surgical techniques are applied. Postoperatively, a recovery period of 2 to 3 weeks is necessary for the patient to resume daily activities.