REVIEWS OF DR. SCHULER
Most of us have heard of “carpal tunnel syndrome”—a common medical condition resulting from repetitive stress motion of the wrist. But less is known about “tarsal tunnel syndrome.” Tarsal tunnel syndrome is similar to carpal tunnel syndrome since both disorders arise from nerve compression in a confined space.
The tarsal tunnel lies on the inside of the ankle next to the ankle bones, and is covered by a thick protective ligament that aids structures contained within the tunnel—nerves, arteries, veins, and tendons. One of these structures is the posterior tibia nerve, which runs from the inside of the ankle to the foot and is the focus of tarsal tunnel syndrome (http://www.foothealthfacts.org/footankleinfo/tarsal-tunnel-syndrome.htm).
In tarsal tunnel syndrome, the posterior tibial nerve is compressed. So anything that causes nerve compression in the posterior tibial nerve can be a cause of tarsal tunnel syndrome. If you have flat feet you can develop tarsal tunnel syndrome due to the outward tilting of the heel that occurs with “fallen” arches. Anything that occupies space within the tunnel can compress the nerve: swollen tendons, varicose veins, ganglion cysts, and bone spurs are examples of abnormalities that can lead to tarsal tunnel syndrome. Ankle sprains, may cause swelling and inflammation in or near the tunnel. A short first metatarsal bone (Morton’s Toe) can place inordinate pressure on other parts of the foot—leading to conditions that include tarsal tunnel syndrome. (http://www.footcare4u.com). Finally, people suffering from common diseases, such as diabetes, which results in circulation problems, and arthritis, which is caused by joint inflammation, can develop tarsal tunnel syndrome. All of the above occurrences have the potential to compress the posterior tibial nerve.
How do you know if you may have tarsal tunnel syndrome? The symptoms are a tingling, burning, or electric shock sensation, numbness, and pain. These symptoms are usually felt on the ankles inside and on the foot’s bottom. Symptom locations vary in tarsal tunnel syndrome. They can occur in one spot, or expand extend to the heel, arch, toes, and calf (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001796/).
Symptoms being sudden—due to extreme exercise—or due to gradual overuse of the foot over time. Many occupations require prolonged standing or walking. Also, beginning a new exercise program puts you at risk for ankle injuries because you are required to move your body in new and foreign ways. Gradual introduction of new exercise routines is suggested for many health reasons, including avoiding ankle injuries leading to tarsal tunnel syndrome.
Like any other painful medical condition, early treatment is the ideal way to stave off a more chronic syndrome like tarsal tunnel syndrome. Permanent nerve damage can result from neglecting initial symptoms of the disorder. A proper medical evaluation is necessary to diagnose this syndrome, because it can be confused with a number of other medical conditions.
Your podiatrist or foot and ankle surgeon will examine the foot to diagnose the problem and determine loss of feeling. During this examination, the foot’s nerve is tapped and pressed. Advanced imaging techniques can also be used to determine if there’s a mass present causing compression of the nerve.
If you are diagnosed with tarsal tunnel syndrome, you are fortunate to be able to apply a wide range of treatments to your condition with proven results. Some successful nonsurgical treatments include resting, icing for 20 minutes with a 40 minute break in between icing sessions, taking anti-inflammatory drugs like ibuprofen, and wearing a cast to stabilize the foot’s motion while compressed nerve heals. You can also attend physical therapy sessions, which can include ultrasound therapy and exercise. Injections can also help. A local anesthetic can provide pain relief, and steroids are commonly used to treat inflammation (http://www.footcaredirect.com/tarsal_tunnel.html).
Proper, well-fitting shoe wear is critical to prevent and treat tarsal tunnel syndrome. Shoes with a wide box toe and solid ankle support are best. Prescribed custom shoe inserts provide arch support and prevent nerve compression by restricting motion. Flat footed patients or those with severe nerve damage can relieve pressure on the foot with a brace.
In some extreme cases, surgery is the best option for treating tarsal tunnel syndrome. Your physician will determine is nerve damage is already extreme enough that the nonsurgical treatments will not help prevent the pain and discomfort associated with this ankle condition.