What is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome refers to the condition when the posterior tibial nerve is entrapped in the tarsal tunnel – that space between the bones of the feet and corresponding tissue. It is compared to carpal tunnel syndrome (which happens on the wrist) because they are both triggered by the same cause – a nerve is pinched in a cramped area. The tarsal tunnel is very confined. Once it tightens, it pinches the tibial nerve.

Tarsal Tunnel Syndrome and RSD have long been linked. Reflex Sympathetic Dystrophy (RSD), which refers to recurring pain in the sympathetic nerve system because of triggers like trauma, injury, surgery, or infection, can occur alongside tarsal tunnel syndrome. In RSD, the trigger starts an irregular succession of pain (often intractable) and eventually set off total disability. Tarsal tunnel syndrome can be a coexisting condition together with peripheral neuropathies, thoracic outlet syndrome, and neuromas.

 

What are the symptoms of Tarsal Tunnel Syndrome?

Most patients feel pain on the sole of the foot, often described as a burning or tingling sensation, because the nerves are compressed by entrapment. The pain is usually progressive. It becomes more severe into the day. Rest or elevation (sometimes even a massage) can help provide temporary relief.

 

What causes Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome causes discomfort, sometimes even debilitation. And while it is more common in adults with very active lifestyles, children can develop it as well. The pain is caused by muscles adjacent to the tibial nerve that grow too big. They compact the tibial nerve, which then tries to send signals of pain to the brain. Its neurological impulses are limited, so it does not succeed and instead manifests in a burning or tingling sensation.

Flat-footedness can also cause tarsal tunnel syndrome. The flattened arches force the nerves and muscles surrounding the ankle to veer way from their normal route, squeezing the tibial nerve. Among other tarsal tunnel syndrome causes are cysts, systemic diseases like diabetes and rheumatoid arthritis, and ankle fractures and other similar traumas.

 

Tests and Diagnoses

Diagnosis of this condition is especially confusing because the pain instigated is similar to other conditions. Electrodiagnostic studies seem to help with the diagnosis, especially in cases when there is reason for uncertainty.

 

Treatment Options

There are two kinds of treatment options for tarsal tunnel syndrome – conservative treatment (involving orthotics) and invasive (involving tarsal tunnel syndrome surgery).

The doctor may be partial to conservative measures such as requiring the patient to wear arch supports and more comfortable shoes. Special orthotics can be designed for people with flat feet. These simple approaches are often successful in relieving discomfort. Nonsteroidal anti-inflammatory drugs (better know as NSAIDs) may also be given to patients whose tarsal tunnel syndrome is caused by nerve inflammation. Note, however, that some NSAIDs have heart and gastrointestinal side effects. Take them only as prescribed. Steroid injections may also be administered by the doctor.

Tarsal tunnel syndrome surgery is often a last resort, taken only when conservative treatment approaches fail to relieve the pain and discomfort. In surgery, the surgeon will provide more room the growth of the nerve causing pain. Surgery can also remove cysts encroaching on the nerve (if any).