Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome Treatment

Tarsal Tunnel Syndrome (TTS), also known as posterior tibial neuralgia, is a disorder within the foot resulting in significant pain, despite little mechanical malignancy. The tarsal tunnel houses several vital arteries, ligaments and nerves which travel in this tightly packed space. The walls of the tunnel consist of either bone or tough fibrous material (known as flexor retinaculum), making the inflexibility of these tissues a significant part of the cause of this disorder.

The more pressing concern is what creates the pressure on the tibial nerve within the tunnel that pushes it painfully against these rigid walls. Any tissue which has enlarged in size for any reason can contribute to a case of TTS. This pressure actually creates a variety of symptoms, from tingling to numbness. Over time, pain will worsen as the space within the tunnel decreases.

Diagnosis and Risk Factors of TTS

Various methods can be used to confirm a diagnosis of TTS, but most doctors choose to perform MRI imaging for records and later comparison. Nerve conduction studies may be used, as well as Tinel’s Sign, but they have come under scrutiny in recent clinical trials. It is difficult to classify exact causes for TTS, except for the generalization that anything which creates pressure in the tarsal tunnel may cause TTS. This includes:

  • Tendon inflammation
  • Swelling from injury
  • Benign cysts or tumors
  • Varicose veins (in rare cases)
  • Bone spurs

Additionally, it seems that active individuals with flat feet and athletes in general tend to be more susceptible to TTS. There also seems to be some correlation between TTS and lower back pain; specifically, issues with vertebrae L4, L5 and S1 have been shown to contribute to what is known as “double crush”, a compressed nerve in both the lower back and tarsal tunnel simultaneously.

Treatment of TTS

Treatment of TTS starts with minimally invasive courses of action, including physical therapy, anti-inflammatory drugs and compression garments. If these do not suffice, then cortisone injections may be applied directly to the aggravated area in order to effectively reduce the swelling by the tunnel.

In more severe cases, a surgical release of the tunnel will be performed, cutting open the ankle bone to relieve pressure. This also allows the nerves to be visualized and individually released if needed. Benign tumors, cysts and scar tissue may be removed as well to reduce the space occupancy of the area.

However, with surgery come risks of undesirable effects such as post-operative bleeding and infection, thus increasing the occupied space of the tunnel exponentially. Additionally, the bone and nerves may heal themselves back to their initial positions, negating the surgery in entirety. It is best to discuss with your doctor the advantages and potential risks before deciding upon this method of treatment.

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