What is Tarsal Tunnel Syndrome (Nerve Compression)?
Tarsal tunnel syndrome (TTS), is a compression neuropathy and painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel.
This tunnel is found along the inner leg behind the medial malleolus (bump on the inside of the ankle). The posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles travel in a bundle through the tarsal tunnel.
Inside the tunnel, the nerve splits into three segments. One nerve (calcaneal) continues to the heel, the other two (medial and lateral plantar nerves) continue on to the bottom of the foot. The tarsal tunnel is delineated by bone on the inside and the flexor retinaculum on the outside. (source: wikipedia)
What are the Symptoms of Tarsal Tunnel Syndrome?
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.
What are the Causes?
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 (Observations)
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.
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.
What are the Treatments for Tarsal Tunnel Syndrome (Nerve Compression)?
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.
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.
Even though exercise often worsens the symptoms, rest will not help, so allow all kinds of sporting activities using well fitting 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.
What are some of the possible conditions or diseases that could be causing your symptoms?
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 (Expected Outcome)
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.
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