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What is tarsal tunnel syndrome?

Tarsal tunnel syndrome (TTS) is a nerve-related condition causing pain and numbness in the foot and ankle. Tarsal Tunnel Syndrome occurs when the posterior tibial nerve, which runs through the tarsal tunnel in your ankle, gets compressed. It is also possible that one of the two branches of the tibial nerve, the medial plantar nerve and lateral plantar nerve, may also be compressed. The medial plantar and lateral plantar nerves become compressed when they pass under the flexor retinaculum. Sometimes TTS is also referred to as Posterior Tibial Nerve Neuralgia or Tibial Nerve Dysfunction. It’s similar to carpal tunnel syndrome, but instead of affecting the wrist, Tarsal Tunnel Syndrome impacts the foot. There are two types of TTS, Anterior Tarsal Tunnel Syndrome (nerve compression of the deep fibular nerve) and Posterior Tarsal Tunnel Syndrome, and each carry unique symptoms. We are going to focus on the latter for this blog.

What can cause Tarsal Tunnel Syndrome?

TTS is often caused by anything that compresses or puts pressure on the posterior tibial nerve. The Tibial nerve runs through the tarsal tunnel, inside your ankle and is surrounded by bone and soft tissue. Factors that can lead to TTS include the following:

  • Injuries such as fractures or sprains can cause swelling and changes in the anatomy, leading to compression of the tibial nerve.
  • Foot and ankle deformities, such as flat feet or a ganglion cyst, can reduce the space within the tarsal tunnel, causing pressure on the nerve.
  • Systemic diseases, including diabetes and arthritis, can cause inflammation or swelling in the ankle region.
  • Varicose veins in the tarsal tunnel area can take up space and exert pressure on the tibial nerve.
  • Overuse or strain from prolonged standing or exercising can lead to swelling and inflammation, especially among athletes and individuals in certain occupations that involve extensive use of the feet.
  • Swelling and inflammation due to conditions like tendonitis can cause pressure within the tarsal tunnel.

While these factors may increase the risk, TTS can occur without an obvious cause in some cases.

What are the symptoms of TTS, and how is it diagnosed?

Symptoms of TTS can vary in intensity and frequency, but generally include:

  • Tingling or numbness, often described as a pins-and-needles sensation, typically in the ankle, heel, or along the sole of the foot.
  • Sharp, shooting, or burning pain in and around the ankle and foot.
  • Foot weakness or a feeling of the foot ‘giving way’, which may affect balance or coordination.

Doctors typically diagnose Tarsal Tunnel Syndrome through a physical examination and medical history assessment. Doctors may perform a Tinel’s sign test, which involves tapping on the nerve to elicit symptoms. Further diagnostic tests can include imaging techniques to spot physical abnormalities, and a nerve conduction study or electromyography to confirm the diagnosis and rule out other conditions.

What are the treatment and aftercare options for TTS?

When creating a plan to treat Tarsal Tunnel Syndrome, initial approaches typically involve conservative methods. These include rest and immobilization to promote nerve healing, and using ice packs and nonsteroidal anti-inflammatory drugs to manage inflammation and pain. Orthotic devices or braces and physical therapy can also play significant roles in correcting foot posture and enhancing strength and flexibility. For more severe inflammation, corticosteroid injections might be administered. If these techniques prove insufficient, foot and ankle surgeons may suggest surgery as an option.

Following treatment, physical therapy is often continued to strengthen the foot, and regular medical check-ups are essential to monitor progress and prevent a recurrence. Additionally, management of any underlying conditions that may contribute to TTS is paramount.

Unraveling the silent agony

Don’t let tarsal tunnel syndrome stop you in your tracks. At Texas Orthopaedic Associates, we specialize in providing personalized, comprehensive care for conditions like TTS. Get in touch with us today and take the first step towards pain-free living.