WHAT IS TARSAL TUNNEL SYNDROME:
Tarsal tunnel syndrome (TTS) is a posterior tibial nerve compression neuropathy. Symptoms include pain spreading into the foot, which is generally exacerbated by walking. There is also weakness and atrophy of the small foot muscles, as well as loss of foot sensation.
Tarsal Tunnel Syndrome is caused by any type of tibial nerve entrapment or compression. Idiopathic or posttraumatic causes are common in many patients. Other possible causes include:
- Activities that cause repetitive stress, such as jogging, prolonged walking, or standing
- Injuries such as fractures, dislocations, and stretching
- Varus or valgus heel
- Excessive Weight
- Tarsal tunnel lesions that take up space, such as ganglions, tumors, edema, osteophytes, or varicosities
- Systemic disorders causing ankle inflammation or nerve damage (ex: diabetes mellitus, arthritis)
- Rheumatoid Arthritis.
SIGNS AND SYMPTOMS:
- paraesthesia (burning, numbness, or tingling).
- Shooting pain in the foot’s sole.
- The pain improves with rest and worsens with activities including standing, walking, and driving.
- Tenderness in the area behind the medial malleolus.
- Swelling of the feet.
- Forced eversion and dorsiflexion of the foot increase the symptoms.
- clinical examination and medical history
- Analysis of gait.
- Sensory evaluation.
- Testing for a range of motion.
- Muscle testing by hand.
- Tinel’s sign and other specialized tests
- radiography like ultrasound, MRI, computed tomography, and electromyography (EMG).
- Nerve conduction investigations to evaluate the problematic foot’s digital abductor and flexor muscles.
Use of Physical agents such as:
- Contrast baths
- Interferential current therapy
- Extracorporeal shock wave.
- High-intensity class 4 laser.
- Dry needling.
Orthotics and Taping:
- Plantar arch taping
- Medial heel wedge
- Modified footwear.
- Calf stretching.
- Achilles tendon stretching.
- Plantar fascia stretching.
- Nerve mobility/glides.
- Tibialis posterior strengthening
- Tibialis posterior strengthening in weight-bearing
- Balancing and proprioception exercises.
- Soft tissue massage
- Neural mobilization
- Corticosteroid Injections
- Pain Medications
Surgery is recommended for patients who have not responded to conservative treatments and have problems that interfere with their everyday lives. Surgical treatment options include:
- Posterior Tibial Nerve Decompression