Tarsal Tunnel Syndrome
The tarsal tunnel is the space that is formed between the underlying bones on the inside of the ankle and the overlying soft tissues. It contains the tendons that travel around the inside of the ankle (tibialis posterior, flexor digitorum longus and flexor hallucis longus), along with the tibial nerve and posterior tibial artery. Tarsal tunnel syndrome refers to a condition where the posterior tibial nerve that lies within the tarsal tunnel is compressed.
Tarsal tunnel syndrome can be caused by a variety of pathologies, including fractures, bone spurs, ganglions, benign tumours, muscle impingement, or foot deformities. Other medical conditions such as arthritis can cause swelling of the joints that may compress the nerve. Scar tissue formed after an ankle injury and growth of abnormal blood vessels can also press against the nerve, resulting in compression.
Most people with tarsal tunnel syndrome complain of pain, numbness, and a burning or tingling sensation at the bottom of the foot and heel.
Tarsal tunnel syndrome is diagnosed by a thorough medical history and careful clinical examination. This includes a Tinel’s test, which is performed by tapping the posterior tibial nerve lightly, which produces pain and other symptoms in a tarsal tunnel syndrome.
Tarsal tunnel syndrome may be treated with conservative approaches which include:
- Non-steroidal anti-inflammatory medications to relieve pain and reduce swelling.
- Corticosteroids that are injected into the area around the nerve to decrease the inflammation and swelling.
Surgery is considered when conservative treatments fail to resolve the condition. Surgery involves release of the constricting tissue that’s causing compression of the nerve, as well as removal of causative lesions such as ganglions or soft tissue tumours.