Tarsal Tunnel Syndrome is a condition of the foot and ankle similar to the carpal tunnel syndrome of the wrist and hand. In the leg there are 5 areas where nerves sit in relatively tight anatomical tunnels surrounded by ligaments, tendons, bones and muscles. On occasion these structures can press on the nerve abnormally and cause nerve pain. The tarsal tunnel is an anatomical area located on the inside of the ankle just behind the inner ankle bone ( medial malleolus ). The tunnel extends down into the bottom of the foot in the area just past the heel fat pad. When there is an impingement on the tibial nerve and its small branches in this area the patients can experience numbness on the bottom of the foot, electricity type feeling shooting to the bottom of the foot and the toes, tightness in the inner ankle, or pinpoint pain in the area of the heel.
Very important is this - if a patient has been diagnosed and treated for plantar fascittis or heel spur syndrome without getting any better the cause of the pain or discomfort may be Tarsal Tunnel Syndrome.
The diagnosis is usually based on clinical finding during an examination. A nerve conduction test or CT scan or MRI may be ordered if necessary.
Conservative therapy may consist of physical therapy, stretching excersises, orthotics, and immobilization.
The Surgical treatment is called a tarsal tunnel release ( or decompression ). This happens to be a topic Dr. Gitlin has lectured on since 2003, all over the country at national meetings and medical schools as well. For the surgerical nerve release knowledge of anatomy is absolutely necessary since there are many important structures in the inner ankle area that must be identified and carefully handled. Our patients have a 100% success rate so far since we have developed the minimal incision technique using microscope loupe goggles and a special custom made fiberoptic lighted instrument. Typically the incision for this release is three to five inches long over the tunnel itself and the patient needs to be immobilized non weightbearing until the skin is healed. Our minimal incision technique allows for a thorough nerve release through an incision less than one inch long! The patient is allowed to walk that same day after the procedure in a special shoe and soft bandage.
Below is photo, on the left the old technique of very large incision, on the right the new minimal incision technique.
Unfortunatly we also perform a number of revisional tarsal tunnel releases every year since depending on the technique and patient overall healing ability scarring can occur and damage the nerve structures. This is a very difficult operation but aptient outcomes have been satisfactory as well getting the people back to their regular activities with minimal discomfort. If you are in this situation please call our office we will try our best to help you.
We also perform this procedure as part of our diabetic neuropathy nerve decompression treatment.
There is another similar condition that occurs on the front side of the ankle joint, this is called Anterior Tarsal Tunnel Syndrome. This is rare situation where a tight ligament called a retinaculum pushes down on the deep peroneal nerve. These patients develop a dull ache over the foot and ankle and many time numbness or feelings of electrical tingling occur between the big toe and the second toe next to it. Anterior tarsal tunnel syndrome can be caused by arthritis in the area, previous trauma, deformity, or occasionally for no obvious reason at all. A thorough history and examination helps establish the diagnosis. When the top of the ankle is tapped gently, an electrical shock may be felt going between the first two toes. Electrical testing as well as diagnostic nerve blocks confirm the diagnosis. X-rays and MRIs may be requested to exclude a pinched nerve in the lower back or evaluate previous ankle injuries. Nerve blocks,physical therapy, orthotic therapy, steroid injections, and other pain management techniques may be used for chronic cases. Surgery is not often performed except in cases where conservative therapy does not alleviate symptoms. The procedure is similar to the regular tarsal tunnel release mentioned above.