FOOT & ANKLE

Tarsal Tunnel Syndrome

Tarsal tunnel is the gap that is formed between the underlying bones of the foot and the overlying tough fibrous tissue. Tarsal Tunnel Syndrome (TTS) refers to a condition where the posterior tibial nerve that lies within the tarsal tunnel is compressed. The condition occurs when the tibial nerve is pinched.

Symptoms

Most people with TTS will report symptoms such as pain, numbness and burning or tingling sensation similar to an electric shock at the bottom of the foot and heel. 



Causes

The exact cause of TTS is unknown, however certain conditions such as fractures, bone spurs, ganglions, benign tumours, muscle impingement or foot deformities are known to increase the risk of its development. Other causes may include:

  • Flat feet or fallen arches
  • Other medical conditions such as arthritis or diabetes can cause swelling and nerve compression
  • Scar tissue formed after an ankle injury and growth of abnormal blood vessels can press against the nerve

Diagnosis

Diagnosis is made by medical consultation, taking the patient's past medical history and examination of the foot using Tinel’s test. This is performed by tapping the posterior tibial nerve lightly which produces pain and other symptoms indicating TTS. Advanced imaging studies may be ordered if a mass is suspected or if initial treatment does not reduce the symptoms. Studies used to evaluate nerve problems such as electromyography and nerve conduction velocity (EMG/NCV) may be ordered if the condition shows no improvement with nonsurgical treatment.



Treatment Options

Non Operative Treatment

TTS can be treated with non operative treatments including:

  • Orthotic devices such as specially designed shoe inserts, brace or splits or change in footwear will help support the arch of the foot and take tension off the tibial nerve. 
  • Nonsteroidal anti-inflammatory medications to relieve pain and reduce swelling
  • Corticosteroid injections to the area may also help relieve inflammation
  • Rest, regular application of ice and immobilisation are also helpful to relieve pain and encourage healing.


Surgery

Depending on the severity of the condition and if non operative treatment has been ineffective, surgery may be recommended. Surgical intervention involves a tarsal tunnel release in which an incision is made in the tarsal tunnel and the pressure on the tibial nerve is released.

Share by: