The early clinical presentation of Tarsal Tunnel Syndrome may start with a mild tingling (like an electrical charge) and burning sensation in the sole of the foot. Symptoms are aggravated by prolonged standing and walking but relieved by rest. Paresthesia or “pins and needles pricking sensation” occurs in the distribution of the tibial nerve and its branches.

The affected foot may feel weak and numb in chronic cases. The area under the medial malleolus (inner bone bit of the ankle) may feel pain to palpation and resonate paresthesia if gently tapping by a neurologic hammer, otherwise known as the “Tinel’s sign” which is pathognomonic for Tarsal Tunnel Syndrome. Soft tissue masses like retention cysts, ganglioma or lipoma may directly be palpable below the medial malleolus. Chronic disease may show muscle wasting and loss of bone density in the affected foot.

• Surgical Procedure

  In more severe cases, a surgical procedure called a tarsal tunnel release may be performed to decrease pressure on the nerve from the overlying ligament. [medrebels.com]

  Surgical nerve decompression by a board certified podiatrist is often necessary to alleviate long-term pain. This surgical procedure relieves the scar tissue that has inevitably built up around the nerve causing the pain. [footsmart.com]

  The surgical procedure is called a tarsal tunnel release. It relieves the pressure exerted on the nerve within the tarsal tunnel. [medicinenet.com]

• Disability

  But left untreated, chronic TTS may become disabling and cause permanent nerve damage. A person should consult with a doctor anytime TTS symptoms occur. [medicalnewstoday.com]

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• Toe Pain

  ankle pain, toe pain, and other assorted foot problems. [heelthatpain.com]

  Patients often complain of numbness in the foot all the way through to the big toe. Pain usually is said to worsen throughout the day with activity but relaxes with rest, elevation, and massage. [wcfoot.com]

  Tarsal tunnel syndrome can cause many types of foot pain including burning pain, shooting pain, sharp pain, tingling numbness and aching. It can cause heel pain, ankle pain, bottom of the foot pain and even toe pain.. [footankle.com]

  Symptoms of Tarsal Tunnel Syndrome TTS is characterized by a burning or tingling sensation in the bottom of the foot, usually in the bottom of the mid-foot or further back, near the bottom of the calcaneus (heel bone), and all toes except the little toe [mbmyoskeletal.com]

  […] the toes Pain radiating up into the leg, and down into the arch, heel, and toes Pins and needles type feeling and increased sensation on the feet Burning sensation on the bottom of foot that radiates upward reaching the knee Painful burning, tingling [disabled-world.com]

• Arthritis

  A medical examination and discussion of your symptoms is normally backed up by X-rays to look for bone spurs or arthritis. [fortiusclinic.com]

  Possible causes may include: Having flat feet or fallen arches Swelling caused by an ankle sprain Diseases such as arthritis or diabetes An enlarged or abnormal structure, such as a varicose vein, ganglion cyst, swollen tendon, or bone spur Symptoms of [medrebels.com]

  Xrays of the ankle/foot are requested in patients with deformities or arthritis. MRI may be helpful in delineating any space occupying lesion. [nerveclinic.co.uk]

  Tarsal Tunnel Syndrome occurs when the posterior tibial nerve, as it courses under the ligament at the ankle, becomes inflamed for a variety of reasons, namely: excessive pronation, arthritic problems such as rheumatoid arthritis, trauma, and even obesity [footcaredirect.com]

  The Tarsal Coalition or enlargement of the subtalar joint due to bony spurring from degenerative arthritis may also cause compression along the nerves. [drlox.com]

• Fracture

  This is a report of tarsal tunnel syndrome (TTS) due to a specific malunited calcaneal fracture fragment in a 46-year-old man. He was treated non-operatively for extra-articular calcaneal fracture. [ncbi.nlm.nih.gov]

  Exact cause of the condition is not known but certain conditions such as fractures, bone spurs, ganglions, benign tumors, muscle impingement, or foot deformities are known to increase the risk of developing tarsal tunnel syndrome. [englewoodortho.com]

  It is often misdiagnosed as plantar fasciitis, a stress fracture or peripheral neuropathy. [osc-ortho.com]

  (Broken Ankle) Stress Fracture Stress Fracture Feet Severs Disease Heel Spur Shin Splints Degenerative Conditions Ankle Arthritis Soft Tissue Inflammation Retrocalcaneal Bursitis Biomechanical Conditions Anterior Ankle Impingement Posterior Ankle Impingement [physioworks.com.au]

• Foot Pain

  heel, and ankle — which in turn reduces heel pain, ankle pain, toe pain, and other assorted foot problems. [heelthatpain.com]

  Tarsal tunnel syndrome can cause many types of foot pain including burning pain, shooting pain, sharp pain, tingling numbness and aching. It can cause heel pain, ankle pain, bottom of the foot pain and even toe pain.. [footankle.com]

  Both patients had a long duration of severe foot pain and had been treated with various therapeutic modalities without lasting relief. [ncbi.nlm.nih.gov]

  RESULTS: Of 29 patients, 19 were referred by the orthopedic foot service. Presenting complaint was available in 25 patients, and consisted primarily of pain in 16 and plantar sensory disturbance in 8. [n.neurology.org]

  Tarsal tunnel syndrome pain can be diffuse, and can be an overlooked source of ankle or foot pain unless a skilled clinician is evaluating for the syndrome. [drlox.com]

• Ankle Pain

  We present a 35-year-old man with a 1-year history of unilateral knee, calf, and medial ankle pain with spontaneous movements of second through fifth toes. [ncbi.nlm.nih.gov]

• Leg Pain

  The injured limb had no sensation on the plantar aspect of the foot and heel, decreased active great toe flexion, and associated leg pain. [ncbi.nlm.nih.gov]

  This creates misalignment in your foot and leg, which leads to a host of heel pain and leg pain issues. A more well-known cause of tarsal tunnel syndrome is arthritis, which causes inflammation in the joint of the ankle and leads to damaged nerves. [heelthatpain.com]

  You may feel tingling, numbness and pain in your foot. This pain may also radiate through your ankle and up into your leg. [behzadisportsdoc.com]

  Pain Walking (gait) Disorders [neckandback.com]

• Paresthesia

  Tarsal tunnel syndrome is a common syndrome resulting from compression of the posterior tibial nerve or of the plantar nerves in the tarsal tunnel, characterized by pain and paresthesias. [symptoma.com]

  This consists of the compression of the posterior tibial nerve or its terminal branches at the level of the internal malleolus (inner ankle), causing paresthesias in the sole and pain in the heel (back of the foot) which make walking difficult. [clinicasanroman.com]

  Only a minor degree of paresthesia remains in the forefoot. [ncbi.nlm.nih.gov]

• Neuralgia

  Causes of Tarsal Tunnel Syndrome (TTS) or Posterior Tibial Neuralgia The Following Are Some Common Causes Of Tarsal Tunnel Syndrome or Posterior Tibial Neuralgia: Tarsal tunnel syndrome or posterior tibial neuralgia occurs due to trauma or spontaneous [epainassist.com]

  From Wikidata Jump to navigation Jump to search compression neuropathy and painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel Posterior Tibial Nerve Neuralgia Neuropathy of the posterior tibial nerve [wikidata.org]

  When this nerve is compressed, the resulting condition is called posterior tibial neuralgia, or tarsal tunnel syndrome. Tarsal tunnel syndrome may be caused by an injury, disease, or due to the natural shaping of the foot. [medrebels.com]

  Nonsurgical management includes the use of anti-inflammatory medications and other medications used for neuralgia. [aaos.org]

  The condition is known as Posterior Tibial Neuralgia and is mainly caused due to repetitive activities that put strain on the ankle. [orthotexas.com]

• Peripheral Neuropathy

  Alternative Names Tibial nerve dysfunction; Neuropathy - posterior tibial nerve; Peripheral neuropathy - tibial nerve; Tibial nerve entrapment Causes Tarsal tunnel syndrome is an unusual form of peripheral neuropathy. [umms.org]

  Tibial nerve dysfunction; Posterior tibial neuralgia; Neuropathy - posterior tibial nerve; Peripheral neuropathy - tibial nerve; Tibial nerve entrapment Katirji B. Disorders of peripheral nerves. [medlineplus.gov]

  It is often misdiagnosed as plantar fasciitis, a stress fracture or peripheral neuropathy. [osc-ortho.com]

  After excluding four patients with peripheral neuropathy, a definite delay in the distal motor latency of the tibial nerve was documented in 11 subjects (25%). Two of the 11 had foot symptoms suggestive of TTS. [ncbi.nlm.nih.gov]

• Sciatica

  Shin Splints Degenerative Conditions Ankle Arthritis Soft Tissue Inflammation Retrocalcaneal Bursitis Biomechanical Conditions Anterior Ankle Impingement Posterior Ankle Impingement Pes Planus (Flat Feet) Nerve-Related Sources Tarsal Tunnel Syndrome Sciatica [physioworks.com.au]

A good detailed clinical history revealing the characteristic early tingling and pain in the foot may point in the direction of an early nerve compression disease. History of injury and inflammation of the ankle will also be a mitigating clue in the diagnosis of Tarsal Tunnel Syndrome.

A comprehensive neurologic exam may elicit a positive Tinel’s sign which is positive in 67% of all cases [5]. Radiographic X-ray may not be of value for it does not show signs of a damaged nerve but could be helpful in determining the extent of over-pronation while weight is applied.

Sonogram imaging, Computed Tomography Scan and Magnetic Resonance Imaging may elucidate masses and cysts that impedes the tunnel space. Nerve conduction studies may only be positive distally during the late course of the disease.

The goal of the treatment of Tarsal Tunnel Syndrome is to relieve the impending stress that compresses the tunnel. Corrective shoes or the use of orthotic appliances to restore the normal arch of the foot may alleviate the symptoms. Custom orthotics have been found to alleviate symptoms of Tarsal Tunnel Syndrome and restore functionality in a study group of factory workers [6]. Inflammation of the ankle and the persistent irritation of the nerve may be allayed by oral anti-inflammatory agents.

Refractory cases may benefit from corticosteroid injection to the tunnel to control swelling. Physical therapy using the Graston’s manual technique or the active decompression release techniques have shown promising results in alleviating pain with professional hands [7]. On the average, surgical intervention ensues at the sixteenth (16th) month of unsatisfactory non-surgical approach [8].

The surgical approach to the decompression is to release the flexor retinaculum by resecting the tendon along the line of the tibial nerve. When the fibrous sheath is released, the tarsal tunnel will loosen up relieve the compression symptoms. Physical therapy post-surgically is also required to properly position the tibial nerve during the healing process and the scar tissue formation of the retinaculum.

When the tibial nerves are not aligned, the scarring tissue may impinge it again and cause a relapse in symptomatology; thus requiring a scar tissue or fascial stripping operation [9]. A Gondring scoring system to determine the intensity of the pain during follow-up visits could help quantify the pain symptoms and predict patient’s recovery outcome [10].

The outlook for patients suffering from Tarsal Tunnel Syndrome is basically encouraging. Segments which are treated medically may experience pain-free remissions of long duration.

Surgical decompression of the trapped nerve gives a better prognosis to patients. Physical therapy alleviates pain and function in both medical and surgical cases of Tarsal Tunnel Syndrome.

Complications

The compression signs and symptoms of Tarsal Tunnel Syndrome like gnawing pain and numbness may remain the only fleeting remnant of a mild disease if left untreated.

However, complications from severe and long standing nerve compression may present with muscle atrophy and loss of tactile and temperature sensation of the affected distal digits. Neuro-arthropathy may result from the chronic compression of the proximal afferent nerve. Trophic signs of hair loss and ulcerations may be eminent in with irreversible nerve damage.

There are a number of health conditions that results to Tarsal Tunnel Syndrome, all of these compress the small space of the tarsal tunnel through which the tibial nerve, nerve branches, and vessels pass. Most common of which occurs among middle aged adults with flat foot.

Soft tissue masses may causes compression to the tunnel like ganglioma, ranula, varicosities, neuroma, schwannoma, tendon sheath ganglia and lipoma [2]. Bony spurs like exostoses may also compress this space. A valgus deformity of the rear foot was also demonstrated to have caused these symptoms as well [3]. Ankle injuries and systemic diseases like Diabetes Mellitus and Rheumatoid Arthritis can cause localized swelling impinges the tarsal nerve in this tunnel.

Tarsal Tunnel Disease is a slow and progressive disease that is most commonly seen in patients with ages 30 to 40 years old. People who tend to roll their foot inward or “overpronate” tend to develop compression signs in time.

Obese people with recent foot and ankle injury may have a higher risk for Tarsal Tunnel Syndrome. Studies have shown that people who often run or jog notices the signs and symptoms the earliest. In a significant percentage of these patients Tarsal Tunnel Syndrome has no particular cause and thus labelled idiopathic in origin.

The pathophysiology of Tarsal Tunnel Syndrome stems as a compression neuropathy of the tibial nerve and its branches. Current studies of podiatry and neurosciences have demonstrated that compression injuries to the foot can cause both tension and compression symptoms.

Tension is caused by the direct pulling of the nerve causing a local effect like those exemplified in nerve injuries. Nerve compression injuries dwell with the premise that the axoplasm (nerve endoplasm) transmits and receives nerve impulse, thus any compression may damage the whole segment distally.

Nutrient flow is usually towards the distal axoplasm making the distal nerves more susceptible to injury than the compressed segment proximal nerve segment [4].

Patients born with flat foot or Pes planus deformity should submit to early physical therapy or the use of othotics to mimic the planar arch of the foot to prevent the occurrence of Tarsal Tunnel Syndrome before they reach the age of 30 – 40 years old.

Diabetics who are more prone to Tarsal Tunnel Syndrome must make regular visits to their podiatrists for a regular foot assessment. Arthritic patients must medically control foot inflammation to prevent nerve compression in the Tarsal tunnel.

Tarsal Tunnel Syndrome is a clinical disease caused by the compression of the posterior tibial nerve in the tarsal tunnel of the foot. The tarsal tunnel is just a small and narrow space inside the ankle which lies directly under the bony protrusion in the medial side of the foot. The tibial nerve and its branches are compressed at the level of the flexor retinaculum (thick fibrous band in the ankle) of the foot [1].

Mechanical pressure on the tibial nerve causes numbness and a burning sensation at the plantar (bottom) aspect of the foot. Tarsal Tunnel Syndrome is very common in people with flat foot (Pes Planus) that are devoid of the natural arch in the foot causing the weight of the body to compress the tarsal tunnel.

The early identification of the risk factors for the Tarsal Tunnel Syndrome and the early detection of its primary signs is as important as its treatment. Patients should continually be conscious of any unusual sensation or deformity in their foot and should seek medical consult. One must also remember that compression in the tarsal tunnel is governed by many modifiable factors like weight control, proper walking and running gait, and correct use of footwear.

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