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.
Entire Body System
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. [symptoma.com]
Pain that worsens with standing and walking, yet eases when resting. Increased pain when wearing shoes. More intense pain at night. Initial relief may be found with massage, foot and ankle range of motion exercises and leg elevation. [footsmart.com]
The pain can vary from prickly points in the foot to severe burning pain along the entire foot and ankle area. The pain generally gets worse with activity, especially prolonged walking or standing and improves with rest. [stretchcoach.com]
Non-operative treatments for tarsal tunnel syndrome include icing, resting, and over-the-counter pain relievers, anti-inflammatory medications and nerve pain medications. [osc-ortho.com]
Post-operative scar tissue may lead to sensitivity and pain. [footeducation.com]
Having flat feet or severe swelling from an ankle injury can create this compression. The tarsal tunnel refers to the canal formed between the ankle bone and the band of ligaments that stretches across the foot. [medrebels.com]
Inflammatory arthritis – Inflamed joints cause pressure and swelling, and thus can negatively affect the tibial nerve. [footsmart.com]
Inflammation in the tissues around the tibial nerve may contribute to the problem by causing swelling in the tissues and pressure on the nerve. [advantagephysiotherapy.com]
Other medical conditions such arthritis can cause swelling of the joints that may compress the nerve. Scar tissue formed after an ankle injury and growth of abnormal blood vessels can press against the nerve resulting in compression. [englewoodortho.com]
[…] of the toes or ankle In severe cases, the foot muscles are very weak, and the foot can be deformed. [umms.org]
[…] the toes or ankle In severe cases, the foot muscles are very weak, and the foot can be deformed. [medlineplus.gov]
Severe tarsal tunnel syndrome can cause muscle weakness and complete loss of movement or sensation in the foot. Diagnostic tests Treatment Treatment begins with modification of activities that may be contributing to the symptoms. [urmc.rochester.edu]
The syndrome is characterized by pain, weakness, and sensory changes of the foot and ankle. Non-operative measures should be attempted to reduce or remove the external compression along the anterior aspect of the foot and ankle. [ncbi.nlm.nih.gov]
In advanced TTS, particularly with profound weakness and muscle atrophy (wasting), surgery is done to avoid permanent nerve damage. The surgical procedure is called a tarsal tunnel release. [medicinenet.com]
- 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]
- Soft Tissue Mass
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. [symptoma.com]
Ganglionic Cyst or other soft tissue mass; The growth of a cyst or any soft tissue mass behind the ankle bone can compress the nerve. [kansascityfootandankle.com]
If the Tarsal Tunnel Syndrome is caused by a soft tissue mass, then surgical removal of the mass may be necessary. Surgical correction of Tarsal Tunnel Syndrome in the absence of a soft tissue mass has a very low success rate. [ahni.com]
tissue mass, or lump, in the tarsal tunnel. [fortiusclinic.com]
Of the more common causes of the syndrome are soft tissue masses located within the tunnel. These masses include lipomas, swelling of the tendon sheaths, nerve sheath and nerve tumors, accessory muscles and bony protrusions. [optimalperformanceclinic.ca]
- Tinel's Sign
A comprehensive neurologic exam may elicit a positive Tinel’s sign which is positive in 67% of all cases. [symptoma.com]
A positive test is complaints of localized nerve tenderness and/or a positive Tinel's Sign. Diagnostic Accuracy: Unknown. [thestudentphysicaltherapist.com]
For patients with tarsal tunnel syndrome and the comorbidity of diabetic polyneuropathy (DPN), it is concluded that a positive Tinel sign at the tarsal tunnel can predict a positive outcome for pain relief and restoration of sensation in 80% of the people [ncbi.nlm.nih.gov]
Although a positive Tinel sign related to favorable outcomes in some of the reports, this relationship was not evaluated specifically. [doi.org]
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]
- Heel Pain
and ankle — which in turn reduces heel pain, ankle pain, toe pain, and other assorted foot problems. [heelthatpain.com]
Abstract Between 1996 and 1999, we evaluated 286 patients with chronic heel pain. [ncbi.nlm.nih.gov]
Differential diagnosis See also the separate article on Heel Pain. A variety of soft-tissue, osseous, and systemic disorders can cause heel pain: [ 4 ] The most common cause of heel pain in adults is plantar fasciitis. [patient.info]
- 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]
Anti-inflammatory medication and rest may be suggested to control the symptoms initially. [midwestbonejoint.com]
Questions, comments, suggestions? Contact Doug Alexander by clicking here. [nervemobilization.com]
Athletes suffering from tarsal tunnel syndrome or posterior tibial neuralgia should take rest for the period suggested by the doctor. [epainassist.com]
If you are still experiencing pain after all other conservative measures have been taken, your doctor may suggest surgery to help relieve your pain and restore your mobility and activity level. [behzadisportsdoc.com]
These findings suggest an arterial etiology of tarsal tunnel syndrome. [ncbi.nlm.nih.gov]
A patient’s feeling of pain or tingling being inflicted by the pressing on the nerve (Tinel’s sign), points to the cause being tarsal tunnel syndrome. [osc-ortho.com]
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. [symptoma.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]
Symptoms include burning or tingling pain that occurs when people walk or wear certain shoes. The diagnosis is based on an examination of the foot and nerve conduction studies. [msdmanuals.com]
- Burning Sensation
Mechanical pressure on the tibial nerve causes numbness and a burning sensation at the plantar (bottom) aspect of the foot. [symptoma.com]
sensation Diagnosis is necessary to determine the severity of the condition, so the appropriate treatment plan can be administered. [medrebels.com]
Individuals who suffer from tarsal tunnel syndrome exhibit symptoms that include tingling, burning sensations, numbness, and shooting pain. These symptoms occur most often at rest or just before sleeping at night. [glorthopedics.com]
Tarsal Tunnel Syndrome Signs and Symptoms When entrapment compresses the nerve, it causes pain, a burning sensation, and tingling on the sole of the foot. [healthcommunities.com]
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]
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]
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 . 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 . 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 . On the average, surgical intervention ensues at the sixteenth (16th) month of unsatisfactory non-surgical approach .
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 . 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 .
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 . 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 . 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 .
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 .
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.
- Bracilovic A, Nihal A, Houston VL, et al. Effect of foot and ankle position on tarsal tunnel compartment volume. Foot Ankle Int. Jun 2006;27(6):431-7.
- Ahn J, El-Khoury G. Radiologic evaluation of chronic foot pain. Am Fam Phys. 2007;76(7):975–983.
- Daniels TR, Lau JT, Hearn TC. The effects of foot position and load on tibial nerve tension. Foot Ankle Int. Feb 1998;19(2):73-8.
- Almeida DF, Scremin L, Zúniga SF, Oh SJ. Focal conduction block in a case of tarsal tunnel syndrome.Muscle Nerve. Sep 2010;42(3):452-5.
- Mondelli M, Morana P, Pauda L. An electrophysiological severity scale in Tarsal Tunnel Syndrome. ACTA Neurol Scand. 2004;109:284–289.
- Zhang J. Chiropractic adjustments and orthotics reduced symptoms for standing workers. J Chiro Med. 2005;4(4):177–181.
- Burke J, Buchberger D, Carey-Loghmani T, Dougherty P, Greco D, Dishman J. A pilot study comparing two manual therapy interventions for carpal tunnel syndrome. J Manip Physiol Ther. 2007;30(1):50–61.
- Bailie DS, Kelikian AS. Tarsal tunnel syndrome: diagnosis, surgical technique, and functional outcome.Foot Ankle Int. Feb 1998;19(2):65-72.
- Aspergen D, et al. Conservative treatment of a female collegiate volleyball player with costochondritis. JMPT. 2007 May;:321–325.
- Gondring WH, Trepman E, Shields B. Tarsal tunnel syndrome: assessment of treatment outcome with an anatomic pain intensity scale. Foot Ankle Surg. 2009;15(3):133-8.