The tarsal tunnel is an area on the inside of the ankle made up of bone and ligament. The posterior tibial nerve and its branches pass through this anatomic tunnel. Tarsal tunnel syndrome occurs from pressure on the posterior tibial nerve in this area and results in pain, numbness, tingling, and burning in the heel and bottom of the foot. Tarsal tunnel syndrome is often misdiagnosed as plantar fasciitis. It should be suspected when conservative treatment aimed at treating plantar fasciitis fails.
What Causes Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome may be caused by trauma to the area, varicose veins or another type of growth in the tarsal tunnel, or scar tissue from surgery or an injury. Also, nerve entrapment in this area can result from swelling of the nerve due to any number of systemic conditions, such as diabetes or previous use of chemotherapy drugs.
Tarsal Tunnel Treatment
Tarsal tunnel syndrome treatment is based on determining what the underlying cause of the tarsal tunnel syndrome is. Nerve conduction studies or quantitative sensory testing can be used by the podiatrists at Certified Foot & Ankle Specialists to help differentiate tarsal tunnel syndrome from other more proximal nerve entrapments, such as those behind in the knee or in the lower back. An MRI or a weight bearing CT scan may also be helpful in determining the underlying cause of tarsal tunnel syndrome.
Conservative Treatment Options for Tarsal Tunnel
Conservative treatment for tarsal tunnel syndrome consists of the use of orthotic insoles, physical therapy, anti-inflammatory medication or medication for nerve pain. Unfortunately, many cases of tarsal tunnel syndrome do not respond to conservative treatment and will require surgery.
Surgery for Tarsal Tunnel Syndrome
Surgery for treating tarsal tunnel syndrome involves the decompression of the tarsal tunnel. This is performed under general anesthesia in an operating room by a certified foot and ankle surgeon, hopefully one with advanced training in peripheral nerve surgery – which our podiatrists have. The surgeon will protect the underlying nerve and blood vessels while releasing or cutting the ligament which is applying pressure to the nerve.
Further, during surgery, the branches of the poster tibial nerve including the medial calcaneal nerve, the medial and lateral plantar nerves must be decompressed depending on the distribution of the pain. If done properly and thoroughly, the outcome of tarsal tunnel surgery to decompress these nerves is very good at relieving pain and restoring patients to function. The surgeons with Certified Foot and Ankle Specialists have advanced training and peripheral nerves surgery and are most capable of properly diagnosing and treating tarsal tunnel syndrome. If you are experiencing pain, numbness, tingling or burning in the heel or sole of your foot, make an appointment with our foot and ankle specialists today.