Tarsal tunnel syndrome affects the posterior tibial nerve attached to the sciatic nerve. The tibial nerve goes through the tarsal tunnel in the ankle. The tarsal tunnel is a tight passageway made up of bone and soft tissue inside the ankle.
What does the tarsal do
A thick, fibrous ligament known as the flexor retinaculum shields arteries, tendons, veins, and nerves housed within the tunnel. Just like carpal tunnel syndrome, which occurs in wrists, repeated compression can damage the posterior tibial nerve resulting in pain inside the ankle and across the foot.
A royal pain in the ankle
Depending on the individual and the severity of the tarsal tunnel syndrome, symptoms will differ. Symptoms can come on suddenly or gradually and are typically associated with excessive or prolonged physical activity. People that have experienced tarsal tunnel problems for a long time, may also feel symptoms during rest or while sleeping. Symptoms include:
- Sharp, shooting pains
- Burning or tingling sensation
- Electric shock sensation
- Pins and needles sensation
These symptoms are usually contained within the ankle, but can also be felt into the foot. Some individuals may experience symptoms in just the ankle, while others may feel symptoms in the heel, arch, and toes. Symptoms may be confused for other conditions like plantar fasciitis (inflammation in the arch of the foot) and heel spurs (bone-like protrusion in the heel).
Compression of tibial nerve worsens pain
There are a number of causes for tarsal tunnel syndrome. Tarsal tunnel symptoms are typically affected by compression of the tibial nerve due to injury or other conditions. People with extremely flat feet can have outward tilting of their heel that produces undue strain on the tibial nerve. Injuries to the affected area like sprains, fractures, or swollen tendons can lead to inflammation and compression of the nerve.
Systemic disorders like arthritis and diabetes can cause overactive inflammation making the tibial nerve more susceptible to compression. Abnormalities like benign bone growths, tumors, lipomas (fatty tissue lump), and varicose veins can also cause compression.
Detecting underlying causes
Affected individuals should visit their primary care doctor for diagnosis and treatment. If a condition is left untreated, the damage can be permanent. Doctors will assess the patient’s medical history and recent trauma to the area. A doctor will then perform a test on nerves in the ankle to detect damage.
Tinel’s test requires a gentle tap on the suspected affected nerve. If a patient feels tingling or pain after the tap or even if they don’t, they may have tarsal tunnel syndrome. Other tests like an electromyography or an MRI may be used to detect other possible causes for the symptoms like nerve dysfunction or bony growths, respectively. A doctor may then refer the patient to an orthopedic surgeon or podiatrist.
At-home and doctor-prescribed treatment
Treatment plans will depend on the severity and types of symptoms. People with tarsal tunnel syndrome may take nonsteroidal medications like ibuprofen to reduce inflammation and alleviate pain. Patients may also employ the RICE treatment of resting, icing, compression, and elevation to reduce inflammation.
Doctors can prescribe steroid injections to reduce inflammation. Braces may be used to limit compression caused by movement. Flat-footed people can use custom-fit shoes to support the arches of their feet. Long-standing cases may require surgery to release and stretch out the ligament. With proper treatment and early detection, people can cure their tarsal tunnel symptoms. However, leaving the affected area untreated may cause permanent nerve damage. To prevent further damage, sufferers should make an appointment with their doctor to detect the cause of their ankle and foot pain.