Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is compression of the
posterior tibial nerve at the level of the ankle. The postorier tibial
nerve, 3 tendons, 2 veins and 1 artery occupy a tight space called the
tarsal tunnel. As they course through this fibro-osseous tunnel bounded
by a thick band of tissue called the flexor retinaculum into the bottom
of the foot, pressure on the nerve by swelling and inflammation of
tendons, veins or a space occupying lesion may cause symptoms ranging
from numbness and tingling to severe pain to the entire foot. It is
similar to Carpel Tunnel Syndrome in the hands and wrist. Diagnosis of
this condition may require nerve studies and imaging such as EMG, NCV
and MRI.
There are four conservative steps to
relieve symptoms of this condition. The first line of conservative
treatment is directed toward reducing inflammation. The use of
anti-inflammatory medication and cortisone injections may be used to
reduce inflammation around the nerve tissue.
Other conservative measures may involve physical
therapy providing deep massage to break up scar tissue within the tunnel
and to assist in mobilization of the constricted nerve. An orthotic may
also be utilized to support the foot to take tension away from the
nerve. If conservative treatment fails to relieve the symptoms, surgical
decompression of the nerve may be required.