Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome

Anatomy

The tarsal tunnel is a space located along the inside (medial side) of the ankle. The roof of the space is known as the laciniate ligament or flexor retinaculum. The tarsal tunnel in the ankle is the equivalent of the carpal tunnel in the wrist. The posterior tibial tendon, flexor digitorum longus tendon, the posterior tibial artery, vein, and nerve, and the flexor hallucis longus tendon all pass through the tarsal tunnel as they travel from the lower leg into the foot.

Condition

Tarsal tunnel syndrome is an entrapment or compression neuropathy that occurs as the posterior tibial nerve is compressed as it travels through the tarsal tunnel into the foot.

Symptoms

  1. Pain
  2. Burning, tingling, or numbness that radiates along the bottom of the foot and to the toes or up the leg
  3. Foot cramping
  4. Swelling of the foot and/or ankle

Diagnosis

Diagnosis is made by a comprehensive foot and ankle exam by Dr. Stewart along with x-rays of the foot and ankle. Additional studies including electromyogram (EMG) and nerve conduction studies, ultrasound, and MRI are sometimes used to help make the diagnosis.

Common causes

  1. Congenital flatfoot or a flatfoot resulting from posterior tibial tendon dysfunction places compression over the tarsal tunnel and the posterior tibial nerve
  2. Enlarged or varicose veins within the tarsal tunnel
  3. Soft tissue mass within the tarsal tunnel
  4. Swelling of the ankle as a result of injury or other disease conditions including venous stasis disease, lymphedema, or congestive heart failure
  5. Obesity leading to flatfoot

Treatment

Conservative care is the 1st line of treatment for tarsal tunnel syndrome. Dr. Stewart will exhaust all conservative treatment prior to recommending surgical intervention.

Conservative treatment for tarsal tunnel syndrome includes:

  1. Immobilization of the foot and/or ankle. Depending on the severity of the condition, this may require cast immobilization with crutches, a walking boot, a hinged ankle foot orthosis with supportive shoe gear, a multi-ligamentous ankle brace with supportive shoe gear, or custom foot orthotics with supportive shoe gear
  2. Modification of physical activity including avoidance of walking, jogging, running, and the elliptical for exercise. Recommended exercises include circuit training, swimming, and bicycling
  3. Treatment of underlying flatfoot deformity or posterior tibial tendon dysfunction
  4. Weight loss
  5. Avoidance of flip-flops, flats, and barefoot walking
  6. Medications including anti-inflammatory medications (NSAIDs), Tylenol, oral steroids, and in some cases narcotic pain medication
  7. Ice and elevation
  8. Compression therapy generally with prescription compression stockings
  9. Immobilization in a cast with crutches, walking boot, hinged ankle brace, or a multi-ligamentous lace up ankle brace
  10. Supportive shoe gear including a motion control running shoe such as Brooks, Asics, New Balance, or Saucony. Keen and Merrell style shoes are also recommended
  11. Custom foot orthotics
  12. Steroid injections

Surgical treatment for tarsal tunnel syndrome includes:

In certain circumstances, conservative treatment is insufficient to treat tarsal tunnel syndrome and surgical intervention is required. If surgery is indicated, Dr. Stewart will decompress the tarsal tunnel by cutting the laciniate ligament or flexor retinaculum. If the tarsal tunnel is the result of a soft tissue mass or enlarged veins then these structures are surgically removed.

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