Tarsal tunnel syndrome is compression of the tibial nerve in the inner part of the ankle, in a place called the tarsal tunnel. The tibial nerve is one of the branches of the sciatic nerve that runs in the back of the leg. It passes between the medial malleolus protrusion of the tibia bone, the talus and calcaneus bones, and the connective tissue called the flexor retinaculum on the posterior-inner side of the ankle. Since this is a relatively narrow place, the nerve can be pinched and injured.
Along with the tibial nerve, the tibialis posterior tendon, flexor digitorum longus tendon, flexor hallucis longus tendon, posterior tibial artery and vein pass through the tarsal tunnel. As the tibial nerve passes through the tarsal tunnel, it divides into terminal branches, the medial and lateral plantar nerves.
Tarsal Tunnel Syndrome Symptoms
People with tarsal tunnel syndrome often experience pain, numbness, or tingling on the inside of the heel or ankle. There may also be different sensations such as electric shock, burning, needle prick. Symptoms may spread to the foot and leg along the course of the tibial nerve. The severity of the complaints and their occurrence may differ from person to person. While the pain may start suddenly in one person, it may gradually increase over weeks in another.
In general, complaints increase with physical activity and decrease with rest. However, if it becomes chronic, pain and burning may continue even at rest. If left untreated, permanent nerve damage may develop. In this case, there may be loss of sensation, the strength of the thumb may decrease, and even muscle thinning may occur. It can cause walking difficulties and make it difficult to do daily activities.
Why Does It Happen?
Compression of the tibial nerve in the tarsal tunnel may be due to many reasons:
- Repetitive stress and microtraumas such as excessive running, walking, standing
- Edema and inflammation caused by trauma such as ankle sprain or fracture
- Flat feet may cause stretching of the tibial nerve, increasing the risk of tarsal tunnel syndrome.
- Growth in the bones adjacent to the tarsal tunnel (benign masses or calcification)
- Nerve compression due to enlargement (varicose) of the veins surrounding the tibial nerve
- Compression of masses such as tumors, lipomas
- Diabetes makes the nerves sensitive.
- being overweight
- Heel turning inwards or outwards (varus or valgus)
Tarsal Tunnel Syndrome Diagnosis
Diagnosis is made by medical history and physical examination. In addition to the characteristic complaints, predisposing factors such as trauma are questioned. The Tinnel test, in which sensitivity is evaluated by tapping the points where the tibial nerve passes, is a special examination method for this problem. Forced outturning (eversion) and pulling up (dorsiflexion) of the ankle may increase symptoms. Nerve function can be evaluated objectively with EMG. With MRI imaging, masses or bone abnormalities that may cause compression in the tarsal tunnel can be detected.
What Diseases Can It Be Confused With?
Heel spurs , plantar fasciitis , polyneuropathy , radiculopathy , metatarsalgia , compartment syndrome may give similar findings.
Tarsal Tunnel Syndrome Treatment
Rest, cold application, compression (wrapping with an elastic bandage) and keeping the ankle elevated (elevation) are the treatment methods that can be applied in the first stage. Pain relievers can reduce both pain and edema. Using ankle braces can reduce pressure on the nerve. If you have flat feet, supporting the arch of the foot by wearing insoles can relieve the stress on the tibial nerve. Strengthening the posterior tibialis from the ankle muscles, stretching the calf muscles, soft tissue massage and tibial nerve mobilization are among the recommended physical therapy techniques. corticosteroid injectionIt can reduce inflammation and edema by applying it to the area where the nerve is compressed. In severe cases where these methods are ineffective, surgery may be required. In the surgery, the flexor retinaculum covering the tarsal tunnel is cut and loosened. Physical therapy is also applied to return to normal life after surgery.