Tarsal Tunnel Syndrome
Dr. Stephen Brigido
Tarsal Tunnel Syndrome is a condition where the end branch of the sciatic nerve called the tibial nerve becomes entrapped behind the inside of the ankle.
What causes Tarsal Tunnel Syndrome?
The cause of this condition varies. It can occur from over-pronation, varicose veins, scar tissue from trauma, and soft tissue masses.
What are the symptoms of Tarsal Tunnel Syndrome?
Patients typically describe a feeling like their “foot is falling asleep” when performing activities such as jogging. Often the discomfort will start with one or two toes becoming numb or having the sensation of “pins and needles”. As the condition progresses, numbness and pain can surround the entire ball of the foot and radiate back towards the ankle.
How is Tarsal Tunnel Syndrome evaluated?
The diagnosis is made using the physical exam as well as modalities such as MRI and nerve conduction studies. MRI can be beneficial in helping the physician understand the cause of the problem. The MRI may show a varicose vein or soft tissue mass that may be compressing the nerve. Nerve conduction studies help the physician understand if the condition has contribution from the lower back and if there are other nerves associated with the problem.
What are the treatment options for Tarsal Tunnel Syndrome?
Conservatively, this is treated with injections and/or oral anti-inflammatories to diminish the inflammation around the nerve. Orthotic support has also been beneficial to take stress off of the tibial nerve by supporting the foot and eliminating the over-pronation. Physical therapy modalities such as ultrasound and electrical stimulation can also help diminish the inflammation around the entrapped nerve. When patients do not have complete relief from conservative treatment a procedure called a tarsal tunnel release is performed. During this procedure, the surgeon will cut the ligament sitting on top of the nerve as well as all of the scar tissue surrounding the nerve. If varicose veins are present, the surgeon will relocate the veins so that they do not interfere with the nerve.
What can I expect after undergoing successful treatment for Tarsal Tunnel Syndrome?
The success of the procedure is very high, especially when treated early. Patients are able to participate in athletic activity after healing has occurred and have no limitations.