Tarsal tunnel syndrome (TTS)
Tarsal tunnel syndrome (TTS) is a painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel. Tarsal tunnel syndrome has also been called posterior tibial neuralgia. Anatomically, this tunnel is found along the inner leg and foot behind the medial malleolus or the bump on the inside of your ankle. The posterior tibial artery, tibial nerve, and the muscle tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles which travel through the tarsal tunnel. As the tibial nerve enters the tunnel it splits into 3 branches. One branch innervates the region over the calcaneus while the other two branches split into the medial and lateral plantar nerves.
Tarsal Tunnel Syndrome accounts for 1.8 million cases a year, which translates to a cost of about $15–$20 billion a year. It is slightly more prevalent in women than men.
Some of the symptoms associated with tarsal tunnel syndrome include: pain and tingling in and around the lower legs and ankles and sometimes the toes, swelling of the feet, burning sensations in the feet and toes, “electric” like shock sensations, radiating pain into the lower leg and down into the arch, heel, and toes, as well as temperature changes in the feet.
Anatomical obstructions often create pressure in the tarsal tunnel. Tarsal tunnel syndrome is caused by anything that produces compression of the posterior tibial nerve. Examples include: flat feet, benign tumors, varicose veins, ganglion cyst, bone spurs, inflammation and swelling around the tunnel. RA (Rheumatoid Arthritis), obesity, and diabetes have been associated with TTS. There is also a possible association with repetitive motion, ie using foot pedals while operating a motor vehicle.
Proper diagnosis of a tarsal tunnel syndrome (TTS) requires a complete medical history and physical examination. Your doctor may tap over the affected nerve. This is called Tinel’s sign. When the test is positive, there is a sustained tingling or an electric shock sensation that occurs when you tap over the affected nerve. Your treating doctor (neurologist) may order imaging (X-rays, CT, or MRI scans) and may perform electro-diagnostic testing (EMG or nerve conduction study) in order to diagnose this condition.
Non-surgical treatment of Tarsal Tunnel Syndrome (TTS) may involve the use of anti-inflammatory medications or steroid injections into the tarsal tunnel to relieve the pressure and swelling. In addition, the doctor may prescribe braces or splints to reduce pressure on the foot and to restrict movement that could cause compression of the tibial nerve. Stretching of the calf muscles may also be of benefit to the patient. Surgical treatment or correction of Tarsal Tunnel Syndrome (TTS) in the absence of an obstruction has a very low success rate. This surgery is called nerve decompression and is designed to release the pressure on the posterior tibial nerve as it passes through the tarsal tunnel.
If you are experiencing any of the above symptoms, please consult your treating doctor immediately.
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