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DEFINITION:
Tarsal tunnel syndrome is an entrapment neuropathy (pressure on the nerve) of the tibial nerve as it courses along the inside aspect of the ankle.
SYMPTOMS:
Pain, numbness, burning and electrical sensations may occur along the course of the nerve, which includes the inside of the ankle, heel, arch and bottom of foot. Symptoms are usually worsened with increased activity such as walking or exercise. Prolonged standing in one place may also be an aggravating factor.
CAUSE:
There are a variety of factors that may cause tarsal tunnel syndrome.
These may include repetitive stress with activities, flat feet, and excess weight. Additionally, any lesion that occupies space within the tarsal tunnel region may cause pressure on the nerve and subsequent symptoms.
Examples of such lesions include tendinitis, hematoma, soft tissue cyst, Varicose veins and lower extremity edema (swelling).
DIAGNOSIS:
The diagnosis of tarsal tunnel is made primarily by the experience
of a podiatric foot and ankle surgeon. A Tinel's sign (radiating pain while tapping the nerve) may be elicited. Temporary relief may be obtained with a diagnostic local anesthetic injection.
Electrodiagnostic studies such as nerve conduction velocity (EMG/NCV) testing may also prove useful.
Magnetic resonance imaging (MRI) may also help to evaluate for local pathology or space occupying lesions.
TREATMENT:
Conservative treatment for tarsal tunnel syndrome includes the use of
nonsteroidal anti-inflammatories, ice, physical therapy, orthotic devices and/or steroid injections.
When conservative treatment is unsuccessful, surgical intervention is
performed by the podiatric surgeon. The surgery involves release of the tibial nerve and its branches from the surrounding tight structures by incising the laciniate ligament, a structure that forms a roof over the nerve bundle.
Postoperatively, a period of protected weightbearing and physical
therapy may be prescribed.
Complications of surgery may include continued nerve pain, tingling
and numbness and the possibility of infection.
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