ANTERIOR TARSAL TUNNEL SYNDROME

Nerves live in different layers of flesh, some are deeper inside, some are right under the skin, and some are protected between bones. Major nerves are usually protected better generally because they are deeper under muscles and fat. One common fact is that the body tries very hard to protect these major nerves SO when nerve crosses a joint it is given some extra protection. As you can imagine when a joint moves it creates a pushing , pulling and even stretching force on nerves so in order to protect them the body creates tunnels. You may have heard of one - the carpal tunnel. This is in the wrist and this flesh tunnel protects the nerves from excessive strain when the hand is moved around. Sometimes natures’ protective system is not quite good enough and repetitive motions can cause an inflammation , we call that carpal tunnel syndrome. Carpal means hand , tarsal means foot.

So in the ankle there is a protective tunnel for the major nerve to the foot - this is called the Tarsal Tunnel; and inflammation and pain in that area we call tarsal tunnel syndrome . That is in the area on the inside of the ankle behind the ankle bone. read our page on this topic if your pain is located there.

WHT IS THE ANTERIOR TARSAL TUNNEL ?

There is one more major nerve into the top of the foot, the deep peroneal nerve and it sits in front of the ankle and on top of the foot in its own tunnel. We call this tunnel the Anterior Tarsal Tunnel - makes sense considering anterior means front.

Occasionally , but not too often the contents of this tunnel can become inflamed and cause irritation and even cause numbness and weakness to the top of the foot and pain around the ankle area. There are many

WHAT ARE SOME POSSIBLE SYMPTOMS?

Unlike other types of foot pain, ATTS is neurological. You might feel:

• Burning or Tingling: Often felt on the top of the foot and radiating into the "web space" between the big toe and the second toe.

• Numbness: A "dead" or dull sensation in that same area.

• Night Pain: Pain that keeps you awake or feels worse when your feet are in certain positions under the covers.

• Weakness: In rare or advanced cases, you might notice difficulty lifting your toes or a slight change in your gait.

HOW CAN WE DIAGNOSE IT?

Because ATTS can mimic other conditions like a herniated disc in the back or a stress fracture, a precise diagnosis is essential.

• The Tinel’s Test: We gently tap over the nerve at the front of your ankle. If this causes a "zing" or tingling sensation into your toes, it’s a strong sign of nerve entrapment.

• Diagnostic Injections: A small amount of local anesthetic can be injected near the nerve. If your pain disappears instantly, we have confirmed the source.

• Advanced Imaging: We use high-resolution Ultrasound or MRI to look for physical causes of compression, such as cysts or thickened tissue.

• EMG/Nerve Conduction Studies: These tests measure how well the nerve is "firing" and can help determine the severity of the pinch.

HOW IS IT TREATED?

Non-Surgical Relief

• Footwear Modification: Simply changing your lacing pattern (skipping the eyelets over the painful area) or switching to shoes with more "volume" can provide immediate relief.

• Custom Orthotics: For patients with high arches, orthotics can realign the foot to take pressure off the anterior tunnel.

• Nerve Gliding Exercises: Specialized physical therapy moves designed to help the nerve "slide" more freely through the tunnel.

• Regenerative Injections: Using ultrasound guidance, we can deliver anti-inflammatory medication or "hydrodissection" (using fluid to create space around the nerve) to relieve pressure.

Surgical Decompression

If conservative care doesn't provide lasting relief, a minor surgical procedure can "release" the tight band of tissue pressing on the nerve.

• High Success Rates: Recent clinical reviews show that surgical release has excellent outcomes, with many athletes returning to full activity within weeks.

• Minimally Invasive: We often perform this through a small, cosmetic incision that heals quickly.

Serving Naples, Fort Lauderdale, and Miami

We evaluate and treat anterior tarsal tunnel syndrome (deep peroneal nerve entrapment) for patients in Naples, Fort Lauderdale, and Miami. If you’re experiencing dorsal foot pain, burning, or first web space numbness, our team can help confirm the diagnosis and guide the right treatment plan.