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Tarsal Tunnel Syndrome

Symptoms of Tarsal Tunnel Syndrome

Tarsal Tunnel syndrome symptoms include:

  • 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
  • Often described as affecting ‘the whole foot’ but on closer examination, it doesn’t usually include the heel.
  • Sensation is described as numbness, electric shock, shooting pain, buzzing.

What Is the Tarsal Tunnel?

Tarsal Tunnel Syndrome
The Tarsal Tunnel

You might have heard of a condition called carpal tunnel syndrome in hands, which is very common.  A similar condition called tarsal tunnel syndrome occurs in the feet.  It is less common but can be very annoying to live with. The biggest difference between the two is that the hand, the condition almost always requires surgery to resolve it, while the foot condition does not. In the hand, all sides of the tunnel are bone.  The hand tunnel can narrow as the bone thickens with age and it may need to be cleaned out with a special surgical drill.

The tarsal tunnel is a narrow space on the medial or inside edge of the foot that runs from behind the inner ankle bone, down and forward to where the arch starts.   In the foot, the tunnel is bordered on one side by soft tissue called the flexor retinaculum. The space contains an artery, vein, nerve and the flexor tendons that move the toes. It is pressure on this nerve (the Posterior Tibial Nerve) which causes the symptoms felt 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.

The most common cause (by far) is flat feet / pronation / fallen arches. In this position, the tarsal tunnel goes from being a short, squat, straight-ish channel to being a elongated and narrowed.  This stretches and compresses the nerve.

Rarer Causes
 of Tarsal Tunnel Syndrome ? Anything that invades the tarsal tunnel space can cause Tarsal Tunnel Syndrome.  This could include swelling in the tendons, a ganglion or other lump.

Diagnosis and 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. 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. This is a condition caused by touching the naked nerve and causing it to become irritated.

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