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| == Tarsal tunnel syndrome ==
| | {{Short description|A condition caused by compression of the tibial nerve in the tarsal tunnel}} |
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| {{Infobox medical condition (new)
| | ==Tarsal Tunnel Syndrome== |
| | name = Tarsal tunnel syndrome
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| | synonyms = '''Posterior tibial neuralgia'''
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| | caption = The mucous sheaths of the tendons around the ankle. Medial aspect.
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| '''Tarsal tunnel syndrome''' ('''TTS'''), is a compression neuropathy and painful foot condition in which the [[tibial nerve]] is compressed as it travels through the [[tarsal tunnel]].<ref name="Yates 2009">{{Cite book |last=Yates |first=Ben |year=2009 |title=Merriman's Assessment of the Lower Limb |edition=3rd |publisher=Churchill Livingstone |location=New York |isbn=978-0-08-045107-7 }}</ref> This tunnel is found along the inner leg behind the medial malleolus (bump on the inside of the ankle). The posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles travel in a bundle through the tarsal tunnel. Inside the tunnel, the nerve splits into three segments. One nerve (calcaneal) continues to the heel, the other two (medial and lateral plantar nerves) continue on to the bottom of the foot. The tarsal tunnel is delineated by bone on the inside and the flexor retinaculum on the outside. | | '''Tarsal tunnel syndrome''' is a medical condition that occurs when the [[tibial nerve]] is compressed as it travels through the [[tarsal tunnel]], a narrow space on the inside of the [[ankle]] next to the [[ankle bones]]. This syndrome is analogous to [[carpal tunnel syndrome]] in the wrist, where the [[median nerve]] is compressed. |
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| | ==Anatomy== |
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| Patients with TTS typically complain of numbness in the foot radiating to the [[big toe]] and the first three toes, [[pain]], burning, electrical sensations, and tingling over the base of the foot and the heel.<ref name="Yates 2009" /> Depending on the area of entrapment, other areas can be affected. If the entrapment is high, the entire foot can be affected as varying branches of the tibial nerve can become involved. Ankle pain is also present in patients who have high level entrapments. Inflammation or swelling can occur within this tunnel for a number of reasons. The flexor retinaculum has a limited ability to stretch, so increased pressure will eventually cause compression on the nerve within the tunnel. As pressure increases on the nerves, the blood flow decreases.<ref name="Yates 2009" /> Nerves respond with altered sensations like tingling and numbness. Fluid collects in the foot when standing and walking and this makes the condition worse. As small muscles lose their nerve supply they can create a cramping feeling.
| | The tarsal tunnel is located on the medial side of the ankle and is formed by the [[flexor retinaculum]], a band of fibrous tissue that stretches from the medial malleolus to the calcaneus. Within this tunnel, the tibial nerve, along with the [[posterior tibial artery]] and [[tendons]] of the [[flexor muscles]], passes into the foot. The tibial nerve branches into the [[medial plantar nerve]], [[lateral plantar nerve]], and the [[medial calcaneal nerve]] as it exits the tarsal tunnel. |
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| ==Symptoms== | | ==Causes== |
| Some of the symptoms are:
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| * Pain and tingling in and around ankles and sometimes the toes
| | Tarsal tunnel syndrome can be caused by any condition that results in compression of the tibial nerve within the tarsal tunnel. Common causes include: |
| * Swelling of the feet and ankle area.
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| * Painful burning, tingling, or numb sensations in the lower legs. Pain worsens and spreads after standing for long periods; pain is worse with activity and is relieved by rest.
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| * Electric shock sensations
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| * Pain radiating up into the leg,<ref name="Yates 2009" /> behind the shin, and down into the arch, heel, and toes
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| * Hot and cold sensations in the feet
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| * A feeling as though the feet do not have enough padding
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| * Pain while operating automobiles
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| * Pain along the Posterior Tibial nerve path
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| * Burning sensation on the bottom of foot that radiates upward reaching the knee
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| * "Pins and needles"-type feeling and increased sensation on the feet
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| * A positive Tinel's sign<ref name="Yates 2009" />
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| [[Tinel's sign]] is a tingling electric shock sensation that occurs when you tap over an affected nerve. The sensation usually travels into the foot but can also travel up the inner leg as well. | | * [[Flat feet]] or fallen arches, which can stretch the tibial nerve. |
| | * [[Varicose veins]] or [[ganglion cysts]] that occupy space within the tunnel. |
| | * [[Inflammation]] from [[arthritis]] or other inflammatory conditions. |
| | * [[Trauma]] or injury to the ankle, leading to swelling or scar tissue formation. |
| | * [[Diabetes]], which can cause nerve damage and increase susceptibility to compression. |
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| ==Causes== | | ==Symptoms== |
| [[File:Tarsal Tunnel.jpg|thumb|3D still showing tarsal tunnel syndrome.]]
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| It is difficult to determine the exact cause of Tarsal Tunnel Syndrome. It is important to attempt to determine the source of the problem. Treatment and the potential outcome of the treatment may depend on the cause. Anything that creates pressure in the Tarsal Tunnel can cause TTS. This would include benign tumors or cysts, bone spurs, inflammation of the tendon sheath, nerve ganglions, or swelling from a broken or sprained ankle. Varicose veins (that may or may not be visible) can also cause compression of the nerve. TTS is more common in athletes and other active people. These people put more stress on the tarsal tunnel area. Flat feet may cause an increase in pressure in the tunnel region and this can cause nerve compression. Those with lower back problems may have symptoms. Back problems with the L4, L5 and S1 regions are suspect and might suggest a "Double Crush" issue: one "crush" (nerve pinch or entrapment) in the lower back, and the second in the tunnel area. In some cases, TTS can simply be idiopathic.<ref name="Yates 2009" />
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| [[File:Normal Arch.jpg|thumb|This is an image of a normal arched foot.]]
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| [[File:Fallen arch (flat feet).jpg|thumb|When comparing to the normal arch image, this image of fallen arches, helps create a visualization of how the tibial nerve can be strained and compressed due to the curvature.]]
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| Rheumatoid Arthritis has also been associated with TTS.<ref>{{cite journal |pmid=7280489 | volume=20 | issue=3 | title=Prevalence of the tarsal tunnel syndrome in rheumatoid arthritis | year=1981 | journal=Rheumatol Rehabil | pages=148–50 |vauthors=Baylan SP, Paik SW, Barnert AL, Ko KH, Yu J, Persellin RH | doi=10.1093/rheumatology/20.3.148}}</ref>
| | The symptoms of tarsal tunnel syndrome can vary but often include: |
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| [[Neurofibromatosis]] can also cause TTS. This is a disease that results in the formation of pigmented, [[cutaneous]] neurofibromas. These masses, in a specific case, were shown to have the ability to invade the tarsal tunnel causing pressure, therefore resulting in TTS.<ref>Mirick, Anika L., Gerald B. Bornstein, and Laura W. Bancroft. "Radiologic Case Study." Orthopedics 36.81 (2013): 154-57. Web. 22 Apr. 2014.</ref>
| | * Tingling, burning, or a sensation similar to an electric shock in the foot. |
| | | * Numbness in the foot or toes. |
| Diabetes makes the peripheral nerve susceptible to nerve compression, as part of the double crush hypothesis.<ref>{{cite journal |vauthors=Dellon AL, Mackinnon SE, Seiler WA | year = 1988 | title = Susceptibility of the diabetic nerve to chronic compression | url = | journal = Ann Plast Surg | volume = 20 | issue = 2| pages = 117–119 | doi = 10.1097/00000637-198802000-00004 }}</ref> In contrast to carpal tunnel syndrome due to one tunnel at the wrist for the median nerve, there are four tunnels in the medial ankle for tarsal tunnel'''s''' syndrome.<ref>{{cite journal |vauthors=Mackinnon SE, Dellon AL | year = 1987 | title = Homologies between the tarsal and carpal tunnels: Implications for treatment of the tarsal tunnel syndrome | url = | journal = Contemp Orthop | volume = 14 | issue = | pages = 75–79 }}</ref> If there is a positive Tinel sign when you tap over the inside of the ankle, such that tingling is felt into the foot, then there is an 80% chance that decompressing the tarsal tunnel will relieve the symptoms of pain and numbness in a diabetic with tarsal tunnel syndrome.<ref>{{cite journal |vauthors=Lee C, Dellon AL | year = 2004 | title = Prognostic ability of Tinel sign in determining outcome for decompression surgery decompression surgery in diabetic and non-diabetic neuropathy | url = | journal = Ann Plast Surg | volume = 53 | issue = 6| pages = 523–27 | doi=10.1097/01.sap.0000141379.55618.87}}</ref>
| | * Pain that radiates from the inside of the ankle into the foot. |
| ==Risk factors==
| | * Symptoms that worsen with activity and improve with rest. |
| Anything compromising the tunnel of the posterior [[tibial nerve]] proves significant in the risk of causing TTS. Neuropathy can occur in the lower limb through many modalities, some of which include obesity and inflammation around the joints. By association, this includes risk factors such as RA, compressed shoes, pregnancy, diabetes and thyroid diseases <ref>{{cite journal |author1=Beltran L. S. |author2=Bencardino J. |author3=Ghazikhanian V. |author4=Beltran J. | year = 2010 | title = Entrapment Neuropathies III: Lower Limb | url = | journal = Seminars in Musculoskeletal Radiology | volume = 14 | issue = 5| pages = 501–511 | doi=10.1055/s-0030-1268070|pmid=21072728 }}</ref>
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| ==Diagnosis== | | ==Diagnosis== |
| Diagnosis is based upon physical examination findings. Patients' pain history and a positive [[Tinel's sign]] are the first steps in evaluating the possibility of tarsal tunnel syndrome. [[X-ray]] can rule out fracture. [[MRI]] can assess for space occupying lesions or other causes of nerve compression. [[Ultrasound]] can assess for synovitis or ganglia. [[Nerve conduction studies]] alone are not, but they may be used to confirm the suspected clinical diagnosis. Common causes include trauma, [[varicose veins]], [[neuropathy]] and space-occupying anomalies within the tarsal tunnel. Tarsal tunnel syndrome is also known to affect both athletes and individuals that stand a lot.<ref name="Yates 2009" />
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| A Neurologist or a Physiatrist usually administers nerve conduction tests or supervises a trained technologist. During this test, electrodes are placed at various spots along the nerves in the legs and feet. Both sensory and motor nerves are tested at different locations. Electrical impulses are sent through the nerve and the speed and intensity at which they travel is measured. If there is compression in the tunnel, this can be confirmed and pinpointed with this test. Some doctors do not feel that this test is necessarily a reliable way to rule out TTS.<ref name="Yates 2009" /> Some research indicates that nerve conduction tests will be normal in at least 50% of the cases.
| | Diagnosis of tarsal tunnel syndrome typically involves a combination of clinical evaluation and diagnostic tests. A healthcare provider may perform a physical examination, focusing on the foot and ankle, and may use the [[Tinel's sign]] test, where tapping over the tibial nerve elicits tingling or pain. Imaging studies such as [[X-rays]], [[MRI]], or [[ultrasound]] may be used to identify structural causes of compression. [[Electromyography]] (EMG) and [[nerve conduction studies]] can assess the function of the tibial nerve. |
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| Given the unclear role of electrodiagnostics in the diagnosis of tarsal tunnel syndrome, efforts have been made in the medical literature to determine which nerve conduction studies are most sensitive and specific for tibial mononeuropathy at the level of the tarsal tunnel. An evidence-based practice topic put forth by the professional organization, the [[American Association of Neuromuscular & Electrodiagnostic Medicine]] has determined that Level C, Class III evidence exists for the use of tibial motor nerve conduction studies, medial and lateral plantar mixed nerve conduction studies, and medial and lateral plantar sensory nerve conduction studies. The role of needle electromyography remains less defined.<ref name="AANEM Practice Topic">{{cite web|title=Usefulness of electrodiagnostic techniques in the evaluation of suspected tarsal tunnel syndrome: An evidence-based review.|url=http://aanem.org/getmedia/51417557-424c-4c29-be6a-5bbaff64517c/TarsalTunnel.pdf.aspx|website=http://aanem.org/getmedia/51417557-424c-4c29-be6a-5bbaff64517c/TarsalTunnel.pdf.aspx|accessdate=15 February 2015}}</ref>
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| Tarsal Tunnel Syndrome (TTS) is most closely related to [[Carpal Tunnel Syndrome]] (CTS). However, the commonality to its counterpart is much less or even rare in prevalence <ref>Ahmad, M. M., Tsang, K. K., Mackenney, P. J., & Adedapo, A. O. (2012). Tarsal tunnel syndrome: A literature review. Foot & Ankle Surgery (Elsevier Science), 18(3), 149-152.</ref> Studies have found that patients with [[rheumatoid arthritis]] (RA) show signs of distal limb [[neuropathy]]. The posterior [[tibial nerve]] serves victim to peripheral [[neuropathy]] and often show signs of TTS amongst RA patients. Therefore, TTS is a common discovery found in the autoimmune disorder of [[rheumatoid arthritis]]<ref>Baylan, S. P., S. W. Paik, A. L. Barnert, K. H. Ko, J. Yu, and R. H. Persellin. "Prevalence Of The Tarsal Tunnel Syndrome In Rheumatoid Arthritis." Rheumatology 20.3 (1981): 148-150.</ref>
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| [[File:Increased ankle loads TTS.jpg|thumb|Increased pressure and high loads on the ankle joint can cause TTS, as can smaller than normal shoes. In this picture, most of the load is placed upon the knee and ankle joint.]] | |
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| == Prevention==
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| The exact cause of Tarsal Tunnel Syndrome (TTS) can vary from patient to patient. However the same end result is true for all patients, the compression of the posterior tibial nerve and it branches as it travels around the [[medial malleolus]] causes pain and irritation for the patient.<ref name="Low 2007">Low, Hu L., and George Stephenson. "These Boots Weren't Made for Walking: Tarsal Tunnel Syndrome." Canadian Medical Association Journal 176.10 (2007): 1415-416.</ref> There are many possible causes for compression of the [[tibial nerve]] therefore there are a variety of prevention strategies. One being [[immobilization (pathology)|immobilization]], by placing the foot in a neutral position with a brace, pressure is relieved from the tibial nerve thus reducing patients pain.<ref>Gondring, William H., Elly Trepman, and Byron Shields. "Tarsal Tunnel Syndrome: Assessment of Treatment Outcome with an Anatomic Pain Intensity Scale."Foot and Ankle Surgery 15.3 (2009): 133-38.</ref><ref>Bracilovic, A., A. Nihal, V. L. Houston, A. C. Beatle, Z. S. Rosenberg, and E. Trepman. "Effect of Foot and Ankle Position on Tarsal Tunnel Compartment Volume." Foot and Ankle International 27.6 (2006): 421-37.</ref><ref>Nakasa, Tomoyuki, Kohei Fukuhara, Nobuo Adachi, and Mitsuo Ochi. "Painful Os Intermetatarseum in Athletes: Report of Four Cases and Review of the Literature." Archives of Orthopaedic and Trauma Surgery 127.4 (2007): 261-64. Print.</ref> [[Eversion (kinesiology)|Eversion]], [[Inversion (kinesiology)|inversion]], and [[plantarflexion]] all can cause compression of the tibial nerve therefore in the neutral position the tibial nerve is less agitated. Typically this is recommended for the patient to do while sleeping. Another common problem is improper footwear, having shoes deforming the foot due to being too tight can lead to increased pressure on the tibial nerve.<ref name="Low 2007"/> Having footwear that tightens the foot for extended periods of time even will lead to TTS. Therefore, by simply having properly fitted shoes TTS can be prevented.
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| ==Treatment== | | ==Treatment== |
| Treatments typically include rest, manipulation, strengthening of [[tibialis anterior]], [[tibialis posterior muscle|tibialis posterior]], [[peroneus]] and short toe flexors, casting with a walker boot, [[corticosteroid]] and anesthetic injections, hot wax baths, wrapping, compression hose, and [[orthotics]]. Medications may include various anti-inflammatories such as [[Anaprox]], or other medications such as [[Ultracet]], [[Neurontin]] and [[Lyrica]]. [[Lidocaine]] patches are also a treatment that helps some patients.
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| ===Conservative treatment (nonsurgical)===
| | Treatment for tarsal tunnel syndrome aims to relieve pressure on the tibial nerve and may include: |
| There are multiple ways that tarsal tunnel can be treated and the pain can be reduced. The initial treatment, whether it be conservative or surgical, depends on the severity of the tarsal tunnel and how much pain the patient is in. There was a study done that treated patients diagnosed with tarsal tunnel syndrome with a conservative approach. Meaning that the program these patients were participated in consisted of [[physiotherapy]] exercises and orthopedic shoe inserts in addition to that program. There were fourteen patients that had supplementary tibial nerve mobilization exercises. They were instructed to sit on the edge of a table in a slumped position, have their ankle taken into [[dorsiflexion]] and ankle eversion then the knee was extended and flexed to obtain the optimal [[tibial nerve]] mobilization. Patients in both groups showed positive progress from both programs.<ref>{{cite journal |vauthors=Kavlak Y, Uygur F | year = 2011 | title = Effects of nerve mobilization exercise as an adjunct to the conservative treatment for patients with tarsal tunnel syndrome | url = | journal = J Manipulative Physiol Ther | volume = 34 | issue = 7| pages = 441–8 | doi=10.1016/j.jmpt.2011.05.017| pmid = 21875518 }}</ref> The medial calcaneal, medial plantar and lateral plantar nerve areas all had a reduction in pain after successful nonoperative or conservative treatment.<ref>Gondring WH1, Trepman E, Shields B. (2008). Tarsal tunnel syndrome: assessment of treatment outcome with an anatomic pain intensity scale. Foot Ankle Surg. 15(3):133-8</ref> There is also the option of localized steroid or [[cortisone]] injection that may reduce the [[inflammation]] in the area, therefore relieving pain. Or just a simple reduction in the patient’s weight to reduce the pressure in the area.<ref>{{cite journal |author1=Edwards William G. |author2=Lincoln C. Robert |author3=Bassett Frank H. |author4=Goldner J. Leonard | year = 1969 | title = The Tarsal Tunnel Syndrome Diagnosis and Treatment | url = | journal = JAMA | volume = 207 | issue = 4| pages = 716–720 | doi=10.1001/jama.1969.03150170042009}}</ref>
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| [[File:Tarsal Tunnel Decompression.png|thumb|Tarsal Tunnel release]] | | * Rest and avoidance of activities that exacerbate symptoms. |
| | * [[Nonsteroidal anti-inflammatory drugs]] (NSAIDs) to reduce pain and inflammation. |
| | * [[Orthotic devices]] or shoe modifications to support the foot and reduce pressure on the nerve. |
| | * [[Physical therapy]] to strengthen the muscles and improve flexibility. |
| | * [[Corticosteroid injections]] to reduce inflammation. |
| | * In severe cases, surgical intervention may be necessary to release the flexor retinaculum and decompress the nerve. |
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| ===Surgical treatment=== | | ==Prognosis== |
| If non-invasive treatment measures fail, tarsal tunnel release surgery may be recommended to decompress the area. The incision is made behind the ankle bone and then down towards but not as far as the bottom of foot. The Posterior Tibial nerve is identified above the ankle. It is separated from the accompanying artery and vein and then followed into the tunnel. The nerves are released. Cysts or other space-occupying problems may be corrected at this time. If there is scarring within the nerve or branches, this is relieved by internal neurolysis. Neurolysis is when the outer layer of nerve wrapping is opened and the scar tissue is removed from within nerve. Following surgery, a large bulky cotton wrapping immobilizes the ankle joint without plaster. The dressing may be removed at the one-week point and sutures at about three weeks.
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| Complications may include bleeding, infection, and unpredictable healing. The incision may open from swelling. There may be considerable pain and cramping. Regenerating nerve fibers may create shooting pains. Patients may have hot or cold sensations and may feel worse than before surgery. Crutches are usually recommended for the first two weeks, as well as elevation to minimize swelling. The nerve will grow at about one inch per month. One can expect to continue the healing process over the course of about one year.
| | The prognosis for tarsal tunnel syndrome varies depending on the underlying cause and the effectiveness of treatment. Many individuals experience relief of symptoms with conservative management, but some may require surgery for lasting relief. Early diagnosis and treatment are important to prevent permanent nerve damage. |
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| Many patients report good results. Some, however, experience no improvement or a worsening of symptoms. In the Pfeiffer article (Los Angeles, 1996),{{full citation needed|date=July 2010}} fewer than 50% of the patients reported improvement, and there was a 13% complication rate. This is a staggering percentage of complications for what is a fairly superficial and minor surgical procedure.
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| Tarsal tunnel can greatly impact patients' quality of life. Depending on the severity, the ability to walk distances people normally take for granted (such as grocery shopping) may become compromised. Proper pain management and counseling is often required.
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| Results of surgery can be maximized if all four of the medial ankle tunnels are released and you walk with a walker the day after surgery. Success can be improved to 80%.<ref>Mullick T, Dellon AL. Results of decompression of four medial ankle tunnels in the treatment of tarsal tunnels syndrome. J Reconstr Microsurg. 2008;24:119-126.</ref>
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| ==Incidence==
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| Though TTS is rare, its cause can be determined in 70% of reported cases. In the workplace TTS is considered a [[musculoskeletal disorder]] and accounts for 1.8 million cases a year, which accumulates to about $15–$20 billion a year <ref name="Jeffress, Charles N 2014">. Jeffress, Charles N. "Work-related Musculoskeletal Disorders (MSDs)." Work-related Musculoskeletal Disorders (MSDs). Occupational Safety & Health Administration, n.d. Web. 11 May 2014.</ref> New studies indicate an occurrence of TTS in sports placing high loads on the ankle joint (3). This can be seen in figure 1. TTS occurs more dominantly in active adults, with a higher pervasiveness among women. Active adults that experience more jumping and landing on the ankle joint are more susceptible (see figure 2). Though athletics and sport are correlations, cases are individualistically assessed because of the oddity.
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| == Athletic activities ==
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| The athletic population tends to put themselves at greater risk of TTS due to the participation in sports that involve the lower extremities. Strenuous activities involved in athletic activities put extra strain on the ankle and therefore can lead to the compression of the tibial nerve.<ref>Kinoshita, M. "Tarsal Tunnel Syndrome in Athletes." American Journal of Sports Medicine 34.8 (2006): 1307-312.</ref> Activities that especially involve sprinting and jumping have a greater risk of developing TTS. This is due to the ankle being put in eversion, inversion, and plantarflexion at high velocities. Examples of sports that can lead to TTS include basketball, track, soccer, lacrosse, snowboarding, and volleyball.<ref>Ramani, William, David H. Perrin, and Tim Whiteley. "Tarsal Tunnel Syndrome: Case Study of a Male Collegiate Athlete." Journal of Sports Rehabilitation 6 (n.d.): 364-70.</ref> Participation in these sports should be done cautiously due to the high risk of developing TTS. However athletes will tend to continue to participate in these activities therefore proper stretching, especially in lower extremities, prior to participation can assist in the prevention of developing TTS.
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| [[File:Tarsal Tunnel Syndrome Foot Positions.jpg|thumb|Placing the foot in Eversion (top left), Inversion (bottom left), or Plantar flexion(right) all put strain on the tibial nerve. These positions should be avoided to prevent the development of TTS and can be done so by using a brace to place the foot in a neutral position.]]
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| ===Famous case===
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| According to South Korea's National Intelligence Service, North Korean leader Kim Jong Un had surgery to correct TTS in his right ankle, the source of a pronounced limp. Kim's disappearance from public for six weeks around the suspected surgery created worldwide speculation about the future of Kim and North Korea.<ref>http://www.cnn.com/2014/10/28/world/asia/kim-jong-un-cyst/index.html?hpt=wo_c2</ref>
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| ==Society==
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| As stated earlier, [[musculoskeletal disorders]] can cost up to $15–$20 billion in direct costs or $45–$55 billion in indirect expenses. This is about $135 million a day <ref name="Jeffress, Charles N 2014"/> Tests that confirm or correct TTS require expensive treatment options like x-rays, CT-scans, [[MRI]] and surgery. 3 former options for TTS detect and locate, while the latter is a form of treatment to decompress [[tibial nerve]] pressure <ref>Manasseh, N., Cherian, V., & Abel, L. (2009). Malunited calcaneal fracture fragments causing tarsal tunnel syndrome: A rare cause. Foot & Ankle Surgery (Elsevier Science), 15(4), 207-209.</ref> Since surgery is the most common form of TTS treatment, high financial burden is placed upon those diagnosed with the rare syndrome.
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| ==See also==
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| * [[Carpal tunnel syndrome]] | | * [[Carpal tunnel syndrome]] |
| * [[Cuboid syndrome]] | | * [[Peripheral neuropathy]] |
| | | * [[Plantar fasciitis]] |
| ==References==
| | * [[Flat feet]] |
| {{Reflist}}
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| == External links ==
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| {{Medical resources
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| | DiseasesDB = 32754
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| | ICD10 = {{ICD10|G|57|5|g|50}}
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| | ICD9 = {{ICD9|355.5}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus =
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| | eMedicineSubj = orthoped
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| | eMedicineTopic = 565
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| | MeshID = D013641
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| }}
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| {{PNS diseases of the nervous system}}
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| | [[Category:Neurological disorders]] |
| [[Category:Foot diseases]] | | [[Category:Foot diseases]] |
| [[Category:Syndromes]]
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| {{stub}}
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A condition caused by compression of the tibial nerve in the tarsal tunnel
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is a medical condition that occurs when the tibial nerve is compressed as it travels through the tarsal tunnel, a narrow space on the inside of the ankle next to the ankle bones. This syndrome is analogous to carpal tunnel syndrome in the wrist, where the median nerve is compressed.
Anatomy
The tarsal tunnel is located on the medial side of the ankle and is formed by the flexor retinaculum, a band of fibrous tissue that stretches from the medial malleolus to the calcaneus. Within this tunnel, the tibial nerve, along with the posterior tibial artery and tendons of the flexor muscles, passes into the foot. The tibial nerve branches into the medial plantar nerve, lateral plantar nerve, and the medial calcaneal nerve as it exits the tarsal tunnel.
Causes
Tarsal tunnel syndrome can be caused by any condition that results in compression of the tibial nerve within the tarsal tunnel. Common causes include:
Symptoms
The symptoms of tarsal tunnel syndrome can vary but often include:
- Tingling, burning, or a sensation similar to an electric shock in the foot.
- Numbness in the foot or toes.
- Pain that radiates from the inside of the ankle into the foot.
- Symptoms that worsen with activity and improve with rest.
Diagnosis
Diagnosis of tarsal tunnel syndrome typically involves a combination of clinical evaluation and diagnostic tests. A healthcare provider may perform a physical examination, focusing on the foot and ankle, and may use the Tinel's sign test, where tapping over the tibial nerve elicits tingling or pain. Imaging studies such as X-rays, MRI, or ultrasound may be used to identify structural causes of compression. Electromyography (EMG) and nerve conduction studies can assess the function of the tibial nerve.
Treatment
Treatment for tarsal tunnel syndrome aims to relieve pressure on the tibial nerve and may include:
Prognosis
The prognosis for tarsal tunnel syndrome varies depending on the underlying cause and the effectiveness of treatment. Many individuals experience relief of symptoms with conservative management, but some may require surgery for lasting relief. Early diagnosis and treatment are important to prevent permanent nerve damage.
Related pages
