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Tarsal tunnel syndrome refers to the entrapment of the tibial nerve under a soft tissue or ligamentous structure known as the flexor retinaculum at the inner ankle. This area is known as the tarsal tunnel. The flexor retinaculum basically holds and protects tendons, the tibial nerve, and the posterior tibial artery behind the medial malleolus or inner bump on the ankle. Bone spurs, inflammation, soft tissue masses, varicose veins, flat feet and any other condition exerting pressure on the flexor retinaculum can cause tarsal tunnel syndrome.
Symptoms of tarsal tunnel syndrome include pain and tingling sensations known as paresthesias that can radiate from the inner ankle to the toes or up to the body. The pain may also feel like a burning or pins and needle sensation.Often due to compression of the tibial nerve where it splits into branches that extend down to the heel. Heel pain causes this condition to be mistaken for plantar fasciitis.
Diagnosis is often first done through history and physical examination. Often a tinnel sign will be evident where tapping on the tibial nerve at the inner ankle reproduces symptoms that radiate toward the toes. Then tests will be done to evaluate the cause of tarsal tunnel syndrome or to rule out other conditions. X-rays can be used to rule out stress fractures of the heel bone and to see if there are any osseous or bony deformities causing compression of the nerve. MRI may be ordered to see if any soft tissue masses are causing pressure on the nerve. Ultrasound may be used to rule out plantar fasciitis.
Treatment will depend on the cause. Initial treatment should be rest, ice and possible NSAIDs. Injections of local anesthetic and corticosteroids may also help reduce symptoms quickly. If swollen tendons or flat feet are causing pressure on the nerve then stretching and orthotics may also help. If these conservative treatments fail then surgery to release the soft tissue structures and decompress the tarsal tunnel can be necessary.
If you are suffering from posterior tibial tendonitis, please do not wait to see a podiatrist. The physicians at Atlantic Foot and Ankle Associates take a conservative approach for all types of injuries. Make an appointment at one of our four offices conveniently located in Palm Coast, Orange City, Daytona Beach, and Port Orange and get back to walking pain free!
By James Rust, DPM
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Daytona Beach, FL 32117