Tarsal tunnel syndrome is a nerve compression disorder that occurs when the posterior tibial nerve and its branches (medial plantar, lateral plantar, and calcaneal nerves) become compressed or irritated as they pass through a narrow tunnel called the tarsal tunnel located just behind the ankle. This condition leads to symptoms such as pain, tingling, and numbness in the sole of the foot and the inner part of the ankle, significantly impacting the quality of life.
People with tarsal tunnel syndrome often choose medication to relieve their pain. This approach may be effective during the early and mild stages of the condition. However, as the syndrome progresses and the underlying cause remains untreated, medications often become insufficient. In such cases, surgery is planned to release the compressed nerve and its branches.
What is Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome is a condition caused by the compression of the posterior tibial nerve and its branches within a narrow channel called the tarsal tunnel, located on the inner side of the ankle. This tunnel is surrounded by connective tissue that supports the nerves and tendons.
When the nerve is compressed or irritated, symptoms such as pain, tingling, and numbness typically develop in the sole of the foot and heel area. As the nerve compression intensifies, these symptoms can significantly affect the quality of daily life.
What Causes Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome has a variety of causes, most of which involve nerve compression or irritation:
Flat Feet (Pes Planus): Flat feet can create abnormal stress and strain in the ankle and tarsal tunnel, putting pressure on the posterior tibial nerve.
Anatomical Variations: Some individuals may have nerve, muscle, vessel, or bone structures that differ from the norm, causing compression of the nerve in the tarsal tunnel.
Masses and Cysts: Ganglion cysts, lipomas, or nerve sheath tumors in the tarsal tunnel area can press on the nerve and lead to tarsal tunnel syndrome.
Injuries and Trauma: Ankle sprains, fractures, or other traumatic injuries may compress the nerve and result in the symptoms of tarsal tunnel syndrome.
Systemic Diseases: Conditions such as diabetes, rheumatoid arthritis, and hypothyroidism increase the risk of tarsal tunnel syndrome due to their association with nerve damage or inflammation.
This comprehensive explanation helps users understand the various contributing factors to tarsal tunnel syndrome and highlights the importance of identifying the underlying cause for proper treatment.
Which Nerve Gets Compressed in Tarsal Tunnel Syndrome?
In tarsal tunnel syndrome, the posterior tibial nerve and its three branches—medial plantar, lateral plantar, and calcaneal nerves—become compressed. During tarsal tunnel surgery, it is essential to release not only the main posterior tibial nerve but also its three branches to ensure effective relief.
What are the symptoms of Tarsal Tunnel Syndrome?
Symptoms of nerve compression in the foot typically manifest as pain and burning sensations in the ankle and sole. These complaints are consistent with neuropathic pain caused by nerve compression.
Pain: Pain in the ankle, heel, and sole, especially worsening after prolonged standing or walking.
Tingling: Tingling and numbness in the ankle and sole are among the most common symptoms.
Numbness: Numbness caused by nerve compression is usually concentrated in the ankle and sole.
Electric Shock-like Pain: Some patients report sudden, sharp, and intense pains resembling electric shocks.
Night Pain: During sleep, foot positioning can increase pressure in the tarsal tunnel, intensifying posterior tibial nerve compression. This may result in burning foot pain severe enough to disrupt sleep.
Weakness in Toes: In advanced cases, severe nerve compression may lead to weakness in the toes.
These symptoms significantly impact daily life and may progress if not addressed promptly. Early diagnosis and treatment are essential for managing these issues effectively.
How Is Tarsal Tunnel Syndrome Diagnosed?
The diagnosis of tarsal tunnel syndrome is based on the evaluation of the patient’s symptoms, medical history, and physical examination findings.
Radiologic Imaging Studies: X-rays, MRIs, and ultrasounds are used to detect masses, abnormalities in bone structures, and other issues in the ankle and tarsal tunnel area.
Nerve Conduction Studies: Tests such as electromyography (EMG) assess nerve function, confirming the diagnosis and determining the severity of nerve damage. However, EMG results may not always be positive in every case of tarsal tunnel syndrome.
This comprehensive diagnostic process helps identify the underlying cause and severity of the condition, paving the way for effective treatment.
Differential Diagnosis of Tarsal Tunnel
If a patient is diagnosed with a heel spur or plantar fasciitis and receives appropriate treatment but does not respond, that is, does not improve, it is useful to review the heel spur or plantar fasciitis diagnosis. The real problem in some patients with plantar fasciitis or heel spurs is that these patients also have tarsal tunnel syndrome.
Treatment of Tarsal Tunnel Syndrome
Treatment for tarsal tunnel syndrome depends on the severity, cause, and duration of the symptoms. It can be categorized into surgical and non-surgical options.
Non-Surgical Treatment Methods for Tarsal Tunnel Syndrome
Protective Measures and Lifestyle Modifications: Reducing activity levels, using appropriate footwear and supportive insoles (orthotics), and applying rest and ice therapy can help alleviate pain and burning sensations.
Medications: Anti-inflammatory drugs (e.g., ibuprofen) and pain relievers can help reduce pain and inflammation.
Physical Therapy: Physical therapy may include exercises to improve flexibility and muscle strength, reduce swelling, and relieve pain. Methods such as stretching, strengthening exercises, massage, ultrasound therapy, and electrical stimulation can be applied.
Ankle Braces or Splints: These devices can help reduce pressure on the nerve in the tarsal tunnel and alleviate symptoms.
Ultrasound-Guided Cortisone Injections: For severe cases, cortisone injections in the tarsal tunnel area can help reduce inflammation and relieve pain. Ultrasound guidance increases the success rate of these injections.
Is Surgery a Solution for Tarsal Tunnel Syndrome?
Surgery becomes necessary when non-surgical treatment methods fail or when there is a clear cause of nerve compression, such as a cyst or tumor. The goal of tarsal tunnel surgery is to remove the structures compressing the nerve and release it.
During the procedure, both the main posterior tibial nerve and its three branches must be decompressed. The success of the surgery relies heavily on this comprehensive nerve release.
How is Tarsal Tunnel Surgery Performed?
The surgery typically begins by releasing the flexor retinaculum, a band of connective tissue that covers the tarsal tunnel. This relieves pressure on the nerve, alleviating pain and discomfort. The surgeon also removes any cysts, bone protrusions, or other abnormalities pressing on the nerve.
However, the procedure does not end here. The three branches of the posterior tibial nerve, each located within separate tunnels, must also be individually decompressed. Without this, the surgery may not achieve the desired outcome.
Since tarsal tunnel surgery is a specialized procedure, it should be performed by an experienced surgeon. Watch Dr. Utku Erdem Özer perform tarsal tunnel syndrome surgery by clicking this link: Watch the Surgery
Which Doctor Should You See for Tarsal Tunnel Syndrome?
Orthopedics and Traumatology specialists play a primary role in the diagnosis and treatment of tarsal tunnel syndrome. The most accurate physician to evaluate your symptoms is the specialist in this department.
Tarsal Tunnel Syndrome Exercises
Exercises for pinched nerves in the ankle recommended by physiotherapists are very important. These exercises help reduce the pressure on the nerve.
Recommended Exercises:
Ankle stretching exercises
Soft tissue massages
Nerve mobilization techniques
Recovery After Tarsal Tunnel Syndrome Surgery
It is necessary to be careful during the scar formation process after surgery .
Period | Duration | Things to Consider |
Early Postoperative Period | 1-2 Weeks | Absolute rest |
Rehabilitation Period | 4-6 Weeks | Physiotherapy and controlled movement |
Full Recovery | 3-6 Months | Regular checks |
What Happens If Tarsal Tunnel Syndrome Is Not Treated?
Symptoms such as tingling and numbness can progress to permanent nerve damage. Pain in the bottom of the foot can interfere with daily activities.
Possible Complications:
Permanent nerve damage
Muscle weakness
Walking problems
Tarsal Tunnel Syndrome Surgery Comments
Patients who undergo tarsal tunnel syndrome surgery are generally satisfied with the process. Here are some patient comments:
Ahmet Y .: After the surgery, the numbness and tingling in my foot decreased significantly. My movements became much more comfortable.
Leyla K .: Standing for long periods of time was torture for me. After the surgery, my pain has largely disappeared and I can now walk more comfortably.
Murat S .: Before the surgery, I had serious pain, especially at night it was unbearable. Now this pain is completely gone and my sleep pattern is back to normal.
Zeynep A .: I had to stay away from sports due to tarsal tunnel syndrome. After the surgery, I started running again and I do not have any problems.
Frequently Asked Questions About Tarsal Tunnel Syndrome
Is tarsal tunnel syndrome dangerous?
If neglected, it can lead to serious nerve damage.
How to relieve tarsal tunnel pain?
It can pass with the right treatment and rehabilitation.
How is the tarsal tunnel test performed?
Diagnosis is made especially by Electromyography (EMG) and nerve conduction studies .
How to get rid of tunnel syndrome?
It can be cured with early diagnosis, medical treatment and, if necessary, surgical intervention.
Conclusion
Tarsal tunnel syndrome is a health problem that can be managed with early diagnosis and the right treatment approach. It is extremely important to consult a specialist and comply with the recommended treatments.
We have come to the end of our article, thank you for reading. If you want, you can take a general look at the home page from the link utkuerdemozer.com .
