Tarsal tunnel syndrome is a painful foot condition in which the tibial nerve is impinged and compressed as it travels through the tarsal tunnel. Tarsal Tunnel Syndrome (TTS) is also known as Posterior Tibial Nerve Neuralgia. TTS is a compression syndrome of the tibial nerve within the Tarsal Tunnel. This tunnel is found along the inner leg behind the medial malleolus (bump on the inside of the ankle). The posterior tibial nerve, a major artery, veins, and tendons travel in a bundle along this pathway, through the Tarsal Tunnel. In the tunnel, the nerve splits into three different paths. 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 made up of bone on the inside and the flexor retinaculum on the outside.
Patients complain typically of numbness in the foot, radiating to the big toe and the first 3 toes, pain, burning, electrical sensations, and tingling over the base of the foot and the heel. 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 doesn’t stretch much, so increased pressure will eventually cause compression on the nerve within the tunnel. As pressure increases on the nerves, the blood flow decreases. 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.
Some of the symptoms are:
- Pain and tingling in and around ankles and sometimes the toes
- Swelling of the feet
- 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.
- Electric shock sensations
- Pain radiating up into the leg, and down into the arch, heel, and toes
- Hot and cold sensations in the feet
- A feeling as though the feet do not have enough padding
- Pain while operating automobiles
- Pain along the Posterior Tibial nerve path
- Burning sensation on the bottom of foot that radiates upward
- “Pins and needles”-type feeling and increased sensation on the feet
- A positive Tinel’s sign
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
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, active people, or individuals who stand a lot. 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.
For more information see one of the Doctors of the New Mexico Foot & Ankle Institute. Please call 505-880-1000 to schedule an appointment.