Tarsal Tunnel Syndrome

  • Tarsal tunnel syndrome

    It is a painful foot condition in which the posterior tibial nerve is trapped in the tunnel as it travels from behind the inside of the heel bone towards the foot.

    Patients having the condition, complain of pain on the inside of the foot from the ankle to the first 3 toes. Pain is either sharp or there can be a tingling sensation radiating along the first toe. Sometimes the whole foot can be painful if the nerve is trapped at a higher level.

    Area where nerve gets trapped
    Area where nerve gets trapped
    Painful areas in tarsal tunnel syndrome
    Painful areas in tarsal tunnel syndrome

    Diagnosis

    Nerve conduction studies will often show a sensory or motor pattern of nerve compression. The level of nerve compression can be ascertained using nerve conduction studies.

    MRI

    MRI will clearly delineate the tunnel, it's bony as well as soft tissue boundaries. Rare causes of tarsal tunnel syndrome include lipoma (lump of fat), aneurysm of posterior tibial artery (blood vessel accompanying the nerve in the tunnel)

    MRI

    MRI showing trapped and thickened nerve

    Treatment

    Treatment of tarsal tunnel syndrome includes rest, physiotherapy and injections. Sufferers might require an ankle brace, boot or a cast. Foot wear with arch support is useful in patients having a flat arch.

    Injection

     Injection for tarsal tunnel
    Injection for tarsal tunnel
    Healed tarsal tunnel surgery
    Healed tarsal tunnel surgery

    Local anesthesia and steroid injections into the tarsal tunnel is quite useful in relieving pain and can work for a while.

    Surgery

    It is done to relieve pressure on the posterior tibial nerve in the tarsal tunnel, if symptoms do not improve after a trial of non-operative management. Your Podiatrist performs Surgery only after confirmation with NCV studies. Nerve conduction studies show slowing in velocity and amplitude. Surgery can be performed either under general anaesthesia or local. Results are good if the release is done completely. Patients should be warned that symptoms do not get better immediately, especially in cases where pressure is chronic.