Symptoms.
- Burning or tingling feet, particularly at night or at rest.
- More activity during the day means worse trouble at night,
- Usually not painful while active
- Almost always described as ‘the whole foot” but on closer examination, doesn’t usually include the heel.
- Numbness, electric shock, shooting pain, buzzing.
What Is the Tarsal Tunnel?
The Tarsal Tunnel
You might have heard of Carpal Tunnel Syndrome in hands, which is very common. A similar condition occurs in the feet which is less common but can be very annoying to live with. The biggest difference between the two is that the carpal tunnel almost always requires surgery to resolve it, while the tarsal tunnel does not.
The tarsal tunnel is a narrow space on the inside of the ankle that runs from behind the inner ankle bone, down and forward to where the arch starts. In the hand, all sides of the tunnel are bone, which is why it has to be drilled out surgically as the bone closes in with age. In the foot, the tunnel is made of soft tissue, specifically the flexor retinaculum, and the space contains an artery, vein, nerve and the flexor tendons. It is the Posterior Tibial Nerve, which is the culprit in tarsal tunnel syndrome.
What Is Tarsal Tunnel Syndrome? Tarsal tunnel syndrome is caused by pressure on the posterior tibial nerve that produces nerve pain in the area that the nerve supplies. It’s a bit like hitting your funny bone and getting the nerve flash down to your hand. In the case of Tarsal Tunnel Syndrome though, the ‘hit’ is a long-term problem that happens every time you take a step.
Causes
of Tarsal Tunnel Syndrome ? Tarsal tunnel syndrome is caused by excessive pressure on the posterior tibial nerve. The most common cause (by far) is flat feet / pronation / fallen arches. In this position, the tunnel goes from being a short, squat, straight-ish gap to being a longer narrowed gap with a kink in it. This stretches and compresses the nerve and causes pain.
Rarer Causes
of Tarsal Tunnel Syndrome ? Anything that invades the space can cause TTS, such as swelling in the tendons, a ganglion or other lump.
Treatment of Tarsal Tunnel Syndrome ? It is important to seek early treatment if you have tarsal tunnel syndrome. If left untreated, the condition may progress and can cause permanent nerve damage.
Diagnosis Tarsal Tunnel syndrome is diagnosed from the clinical appearance of the symptoms and a physical examination of the foot. At Walk Without Pain Podiatry Clinics, we generally confirm the diagnosis by taping the tunnel into an ‘open’ position for a few days. When the diagnosis is correct, the pain will be significantly reduced almost immediately. This being the case, the next step is orthotics to keep the foot in its best position going forward. This has an excellent success rate.
Advanced imaging studies or nerve conduction tests may be may be required if the condition shows no improvement with non-surgical treatment. Very occasionally, surgery may be necessary but it is best kept as a last resort due to the possible complication of post-operative neuropraxia.