Tarsal tunnel syndrome is sometimes referred to as tibial nerve dysfunction or posterior tibial nerve neuralgia. The tarsal tunnel runs along in the inner ankle and foot. Within it is the posterior tibial nerve and other tendons and vascular structures. Tarsal tunnel syndrome is the compression of these structures within the tarsal tunnel. It is similar to carpal tunnel syndrome which occurs in the wrist, but occurs at the ankle and is much less common than carpal tunnel syndrome.
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Symptoms
The predominant complaint is pain directly over the tarsal tunnel (inner ankle) that radiates to the arch and under the foot. Patients with tarsal tunnel syndrome will frequently report a sharp shooting pain in the foot, numbness on the plantar foot surface, and radiation of pain and along the distribution of the posterior tibial nerve. They may also experience pain with extremes of ankle movement and note that foot muscles may be weaker.
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Causes
Tarsal tunnel syndrome causes are divided into 2 categories; intrinsic (factors within the foot/ankle) and extrinsic (outside factors). Extrinsic causes include poorly fitting shoes, trauma, biomechanical abnormalities, post-surgical scarring, systemic diseases such as inflammatory arthritis and diabetes. Intrinsic causes include tendon disease, nerve scarring, bone osteophytes and a mas, such as a tumor or ganglion, etc.
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Treatment
Tarsal Tunnel Syndrome can be managed non-operatively or with surgery. The more conservative approach concentrates on pain reduction with medications, such as Advil and Tylenol, and addressing the biomechanical abnormalities and reducing other extrinsic factors. Properly fitting footwear and custom orthotics will work to manipulate the foot to have better alignment and open the tarsal tunnel space up to minimize impingement. Physical therapy is an important adjunct, and kinesio taping can also be very helpful.
