Tarsal Tunnel Syndrome
Tarsal Tunnel Syndrome - The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (the flexor retinaculum) and ligaments that protects and maintains the structures contained within the tunnel—arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus point of tarsal tunnel syndrome. Tarsal tunnel syndrome is compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot. The posterior tribal nerve and blood vessel are compressed and run down the side of the ankle and runs down the bottom of the foot and into the toes. Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space. This can produce burning, numbness, tingling and pain in the foot.
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. Patients with tarsal tunnel syndrome experience one or more of the following symptoms: Tingling, burning, or a sensation similar to an electrical shock. Numbness Pain, including shooting pain.
When pronation is the main cause anything that can be done to stop the pronation is required. An orthotic with deep heel cups is the best way to achieve this goal.
Diagnosis is typically made by a D.O., M.D., orthopedist, podiatrist, neurologist, and physiatrist. Patients' report of their pain and a positive Tinel's sign are the first steps in evaluating the possibility of tarsal tunnel syndrome. Nerve conduction studies are not common, but
may be used, as clinical diagnosis is possible.
A neurologist usually administers nerve conduction tests. During this test, electrodes are placed at various spots along the nerves in the legs and feet. Both sensory and motor nerves are tested at different locations. Electrical impulses are sent through the nerve and the speed and intensity at which they travel is measured. If there is compression in the tunnel, this can be confirmed and pinpointed with this test. Many doctors do not feel that this test is necessarily a reliable way to rule out TTS. Some research indicates that nerve conduction tests will be normal in at least 50% of the cases. It is possible to have TTS without a positive nerve conduction test.
Treatments typically include rest, manipulation, strengthening of anterior tibialis, posterior tibialis, peroneus and short toe flexors, wearing a walking boot, cortisone injections, and custom foot orthotics. Medications may include various anti-inflammatories, Anaprox, Ultraset, Neurotin, and Lyrica. Lidocane patches are also helpful.
The patient may not respond to conservative treatment and may need surgical treatment or tarsal tunnel release surgery. The incision is made behind the ankle bone and then down towards but not as far as the bottom of foot. The Posterior Tibial nerve is identified above the ankle. It is separated from the accompanying artery and vein and then
followed into the tunnel. The nerves are released. Cysts or other space-occupying problems may be corrected at this time. If there is scarring within the nerve or branches, this is relieved by internal neurolysis. Neurolysis is when the outer layer of nerve wrapping is opened and the scar tissue is removed from within nerve. Following surgery, large bulky cotton wrapping immobilizes the ankle joint without plaster. The dressing may be removed at the one-week point and sutures at about three weeks.
Complications may include bleeding, infection, and unpredictable healing. The incision may open from swelling. There may be considerable pain and cramping. Regenerating nerve fibers may create shooting pains. Patients may have hot or cold sensations and may feel worse than before surgery. Crutches are usually recommended for the first two weeks, as well as elevation to minimize swelling. The nerve will grow at about one inch per month. One can expect to continue the healing process over the course of about one year. Custom foot orthotics, often mis-spelled orthodics, are still required to stop the pronation.
Tarsal tunnel can greatly impact patients' quality of life. Depending on the severity, the ability to walk distances people normally take for granted (such as grocery shopping) may become compromised. Proper pain management, counseling, custom foot orthotics and properly fit supportive shoes are often required to give the patient a higher quality of life.
Once in custom foot orthotics most patients find a 70 to 80 percent relief within the first 4 to 6 weeks. Where should I go In St. Louis to get help from tarsal tunnel syndrome? Go to Sole Control, they will make orthotics that will help you. Will orthotics in St. Louis help with tarsal tunnel syndrome. Yes, orthotics made at Sole Control will help you with the pain that occurs with tarsal tunnel Syndrome. Has any one recommended Sole Control for orthotics for tarsal tunnel syndrome? Yes, I have been to Sole Control by a recommendation from my doctor to make orthotics for me for tarsal tunnel syndrome.