Tarsal Tunnel Syndrome

Synopsis

The tarsal tunnel is a space in the foot formed between bones and overlying fibrous tissue. Within the tarsal tunnel lies a nerve called the posterior tibial nerve. The tarsal tunnel is walled on one side by sturdy bones, and on the other by tough fibrous tissue. Tarsal tunnel syndrome results when the posterior tibial nerve is compressed within the tarsal tunnel. This condition is very similar, in mechanism, to carpal tunnel syndrome in the wrist. Both of these conditions result when a nerve in pinched within a confined space. The tarsal tunnel, as mentioned previously, has little room to give. When the space becomes tight, the tibial nerve is pinched.

area of pain associated with TTS

The cause of tarsal tunnel syndrome is unknown in most cases, but can be the result of fractures, bone spurs, ganglions and other benign tumors, muscle impingement, or foot deformities.

Diagnosis and Treatment

Because of the symptoms of tarsal tunnel syndrome, most patients describe a similar history of symptoms. However, as mentioned previously, the diagnosis of tarsal tunnel syndrome can be confusing. Tapping or squeezing on the nerve as it passes through the tarsal tunnel, the so-called "Tinel's Test," may create the symptoms and indicate tarsal tunnel syndrome as the cause of the problem. Electrodiagnostic studies that detect how well a pulse of electricity conducts through a nerve may also help with the diagnosis if there is any reason for confusion.

Treatment begins with anti-inflammatory medications, and possibly an injection of cortisone into the area around the nerve. Orthotics and changes in footwear may also help to relieve the symptoms.

If none of these measures helps, then a procedure called a tarsal tunnel release may be necessary. This is a surgical procedure performed in the operating room and it lasts about 30 to 45 minutes. When a tarsal tunnel release is performed, an incision is made to open up the tarsal tunnel and decrease pressure on the posterior tibial nerve. This surgery is also very similar to a carpal tunnel release in the wrist.