Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

Featured on Channel NewsAsia

Tarsal Tunnel Syndrome

SYMPTOMS

There is aching or sharp pain around the medial part of the foot and ankle joint, often radiating along the medial or the lateral part of the foot, or towards the plantar fascia insertion.

AETIOLOGY

This syndrome is caused by trapping of the posterior tibia nerve or any of its branches in the tarsal tunnel, most often after scarring from trauma. Other non-traumatic aetiology, such as varicose veins, neuroma or tumours, may also trap the nerve.

CLINICAL FINDINGS

There is tenderness on palpation over the tarsal tunnel and a positive Tinel’s sign is typical. Dysaestesia along the nerve branch distribution is also a common finding.

INVESTIGATIONS

X-ray is usually normal. MRI may show localised oedema in or around the tarsal tunnel and may, if present, identify some causes for the entrapment such as varicose veins or tumours. Nerve conduction tests can show decreased nerve conduction in chronic cases but can be normal in early cases.

TREATMENT

Direct friction over the tarsal tunnel should be minimised by using well-fitting shoes or soft padding. NSAID or a local injection of cortisone may decrease symptoms in mild cases. In chronic cases surgery may be necessary to release the nerve.

REFERRALS

Refer to orthopaedic foot surgeon if the pain is persistent or is getting worse, to investigate the underlying cause of entrapment and for consideration of surgery. In mild cases, the surgeon may suggest orthotics to start with.

EXERCISE PRESCRIPTION

Even though exercise often worsens the symptoms, rest will not help, so allow all kinds of sporting activities using wellfitting shoes but avoiding unnecessary impact.

EVALUATION OF TREATMENT OUTCOMES

Monitor clinical symptoms, which should disappear. Tinel’s sign should be normal. Note that even after successful surgery it can take a very long time (months to a year) before nerve function is normal.

DIFFERENTIAL DIAGNOSES

Plantar fasciitis (entrapped nerve branch may cause radiating pain to insertion of plantar fascia); Deltoid ligament tear (acute injury); OCD of the talus dome (ache, no radiating pain, joint effusion). Note! Tarsal tunnel syndrome may be associated with metabolic diseases such as diabetes or malignant tumours.

PROGNOSIS

Usually good–fair. If symptoms persist over several months, surgery may be indicated. Again the underlying cause of the nerve compression is more important for outcome than the syndrome itself. Even after successful surgery symptoms may persist over one to two years.

Leave a Reply

You can use these HTML tags

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>