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Tarsal Tunnel Syndrome
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Tarsal Tunnel Syndrome
 

Tarsal Tunnel Syndrome - The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (the flexor retinaculum) and ligaments that protects and maintains the structures contained within the tunnel—arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus point of tarsal tunnel syndrome.  Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.  The posterior tibal nerve and blood vessel are compressed and run dwon the side of the ankle and runs down the bottom of the foot and into the toes.  Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.  This can produce burning, numbenss, tingeling and pain in the foot.

 

  

 

Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as:

  • A person with flat feet is at risk for developing tarsal tunnel syndrome, because the outward tilting of the heel that occurs with “fallen” arches can produce strain and compression on the nerve.
  • An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon, and arthritic bone spur.
  • An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
  • Systemic diseases such as diabetes or arthritis can cause swelling, thus compressing the nerve.

Patients with tarsal tunnel syndrome experience one or more of the following symptoms:

  • Tingling, burning, or a sensation similar to an electrical shock
  • Numbness
  • Pain, including shooting pain 

 

When pronation is the main cause anything that can be done to stop the pronation is required.  An orthotic with deep heel cups is the best way to acheive this goal.

 

Diagnosis is typically made by a D.O., M.D., orthopedist, podiatrist, neurologist, physiatrist. Patients' report of their pain and a positive Tinel's sign are the first steps in evaluating the possibility of tarsal tunnel syndrome.  Nerve conduction studies are not common, but may be used as clinical diagnosis is possible.

 

A neurologist usually administers nerve conduction tests. During this test, electrodes are placed at various spots along the nerves in the legs and feet. Both sensory and motor nerves are tested at different locations. Electrical impulses are sent through the nerve and the speed and intensity at which they travel is measured. If there is compression in the tunnel, this can be confirmed and pinpointed with this test. Many doctors do not feel that this test is necessarily a reliable way to rule out TTS. Some research indicates that nerve conduction tests will be normal in at least 50% of the cases. It is possible to have TTS without a positive nerve conduction test. 

 

Treatments typically include rest, manipulation, strengthening of anterior tibialis, posterior tibalis, peroneus and short toe flexors, wearing a walking boot, cortizone injections, and custom foot orthotics.  Medications may include various anti-inflammatories, Anaprox, Ultraset, Neurotin, and Lyrica.  Lidocane patches are also helpful.  

 

The patient may not respond to conservative treatment and may need surgical treatment or tarsal tunnel release surgery. The incision is made behind the ankle bone and then down towards but not as far as the bottom of foot. The Posterior Tibial nerve is identified above the ankle. It is separated from the accompanying artery and vein and then followed into the tunnel. The nerves are released. Cysts or other space-occupying problems may be corrected at this time. If there is scarring within the nerve or branches, this is relieved by internal neurolysis. Neurolysis is when the outer layer of nerve wrapping is opened and the scar tissue is removed from within nerve. Following surgery, a large bulky cotton wrapping immobilizes the ankle joint without plaster. The dressing may be removed at the one week point and sutures at about three weeks.

 

Complications may include bleeding, infection, and unpredictable healing. The incision may open from swelling. There may be considerable pain and cramping. Regenerating nerve fibers may create shooting pains. Patients may have hot or cold sensations and may feel worse than before surgery. Crutches are usually recommended for the first two weeks, as well as elevation to minimize swelling. The nerve will grow at about one inch per month. One can expect to continue the healing process over the course of about one year.  Custom foot orthotics are still required to stop the pronation. 

 

Tarsal tunnel can greatly impact patients' quality of life. Depending on the severity, the ability to walk distances people normally take for granted (such as grocery shopping) may become compromised. Proper pain management, counseling, custom foot orthotics and properly fit supportive shoes  are often required to give the patient a higher quality of life.

 

Sole Control and foot orthotics in properly fit shoes for tarsal tunnel syndrome patients in St. Louis for a better life!

 

Sole Control

9712 Watson Rd

St. Louis, MO 63126

314-822-9494

Why do my toes go numb?  I get numbness and tingling in my toes.  I get pins and needle feeling in my toes.  Could tarsal tunnel syndrome cause heel pain?  Do I have to have surgery for tarsal tunnel?  Will orthotics help me?  Do shoes help with tarsal tunnel?  Will tarsal tunnel cause numbness?  Does tarsal tunnel cause burning in my feet?  Why do my feet burn?  Me feet feel hot.  my feet feel cold.  My feet burn.  Is tarsal tunnel like fibromyalgia?  Why do my toes tingle?  Will shoes help tarsal tunnel syndrome?  Will orthotics help tarsal tunnell?  Is it torsal or tarsal, tunnell or tunnel or tunel syndrome?  How do you spell tarsal tunnel syndrome?  What is the I CD9 code for tarsal tunnel syndrome?  The code for tarsal tunnel syndrome is 355.5.  Will my insurance pay for orthotics for tarsal tunnel syndrome?  You may have coverage for custom made foot orthotics if you have tarsal tunnel syndrome.  Custom made foot orthotics are normally what doctors prescribe for tarsal tunnel syndrome first.  Who should I see in St. Louis for tarsal tunnel syndrome?  Where should I go for tarsal tunnel in St. Louis?  What should I do about tarsal tunnel syndrome?  Get a prescription for custom made foot orthotics.  Bring in your prescription and we will make custom foot orthotics for you.  What is the code for orthotics?  The codes for orthotics are L3000, L3002,  L3010, L3020, and L3030.  Why do my feet go numb.  Why are my feet hot?  Why do my feet sweat?  How much should my feet sweat?  Where is the tarsal tunnel?  The tarsal tunnel is on the inside of your foot just below your ankle bone.  Is there a tendon there?  Yes a tendon, nerve, and a blood vessel are inside the tarsal tunnel.  Is the nerve getting pinched?  Yes, the ligament pinches the nerve.  Does the tunnel pinch the blood vessel?  Yes the ligament pinches the blood vessel too. 

 

Michael Lukowsky, Certified Pedorthist and Webmaster