What are the other Names for this
Condition? (Also known as/Synonyms)
- Entrapment Neuropathy of Distal Tibial Nerve
- Posterior Tibial Nerve Neuralgia
- Tarsal Tunnel Entrapment Neuropathy
What is Tarsal Tunnel Syndrome?
(Definition/Background Information)
- The tarsal tunnel is a small rigid passageway surrounded by bones
and ligaments that lie on the inside of the ankle. This passageway protects an
important central nerve in the ankle, called the tibial nerve
- Tarsal Tunnel Syndrome (TTS) refers to the compression of the
tibial nerve as it passes through the tarsal tunnel
- Overall, middle-aged women are more likely to develop Tarsal
Tunnel Syndrome than men
- Both nonsurgical and surgical methods are available to treat the
condition. The prognosis of Tarsal Tunnel Syndrome is usually excellent with
appropriate and early intervention
Who gets Tarsal Tunnel Syndrome? (Age and Sex
Distribution)
- Tarsal Tunnel Syndrome is most common between the ages of 30 to 40
years old. However, individuals of all ages can develop the condition
- TTS is more common in women than men
- No ethnic or racial preference is seen
- The condition is also predominately seen in athletes who
participate in sports that cause repetitive stress on the ankles
What are the Risk Factors for Tarsal Tunnel Syndrome?
(Predisposing Factors)
Common risk factors of Tarsal Tunnel Syndrome
include:
- Any sport that requires repetitive overuse of the ankle joints,
such as tennis, basket ball
- Women have a higher incidence of TTS
- Chronic inflammatory disorders (such as rheumatoid arthritis)
- High blood glucose levels that result from either an insulin
secretion deficiency (diabetes type II) or an insulin resistance (diabetes type
I) in the body
- Abnormal pressure on the tarsal tunnel due to excessive body
weight (obesity)
- Hormonal or metabolic changes, due to pregnancy or thyroid
imbalance, can increase an individual’s risk of developing the condition
- Factors such as vitamin deficiency and alcoholism can also increase an individual’s
risk of Tarsal Tunnel Syndrome
It is important to note that having a risk
factor does not mean that one will get the condition. A risk factor increases
ones chances of getting a condition compared to an individual without the risk
factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean
that an individual will not get the condition. It is always important to
discuss the effect of risk factors with your healthcare provider.
What are the Causes of Tarsal Tunnel Syndrome? (Etiology)
Currently, the underlying cause of Tarsal Tunnel Syndrome is unknown.
However, several contributing factors that researchers believe are linked to Tarsal Tunnel Syndrome include:
- Individuals with flat feet
- Individuals who participate in sports that require repetitive
overuse of the ankle joints, such as tennis or baseball
- High blood glucose levels that result from an insulin secretion
deficiency (diabetes type II)
- Proteinaceous deposition around the ankle due to hypothyroidism
- Chronic inflammatory disorder (such as rheumatoid arthritis)
- Swelling caused by a sprained ankle, which can compress nerves in
the ankle
- Structural abnormalities, such as varicose veins, ganglion cyst,
inflamed tendon, lipoma, or bone spur, all may compress the nerve
What are the Signs and Symptoms of Tarsal Tunnel Syndrome?
Symptoms of Tarsal Tunnel Syndrome are usually
observed on the inside of the ankle, heel, and bottom of the foot. In some
cases, symptoms may occur in one place. In other cases, symptoms may extend to
the heel, arch, and toes.
Additional signs and symptoms of Tarsal Tunnel
Syndrome include:
- Radiating pain in the ankle
- Tingling sensation, noticeable numbness of the ankle
- Burning sensation on the bottom of the ankle
How is Tarsal Tunnel Syndrome Diagnosed?
Diagnostic
methods that a physician may use to help diagnose Tarsal Tunnel Syndrome
include:
- Physical examination: A thorough physical examination is important in determining if an individual has Tarsal Tunnel Syndrome.
- During this exam, a physician will apply pressure to the tibial nerve for sensation and the strength of the muscles in the ankle, which can be affected by TTS
- Individuals may be asked the list of activities that one may be performing, which cause repetitive motions around the ankle joint
- Individuals are also expected to provide an explanation of the circumstances that led up to the injury. In addition to this, a complete medical history will aid in arriving at a definitive diagnosis
- Blood
tests, such as fasting blood glucose, thyroid function test, and tests for
rheumatoid arthritis, may be performed
- X-ray
of the ankle: X-rays use radiation to produce images of the ankle. It can also
help the physician rule out other possible causes of ankle discomfort, such as
arthritis or a fracture
- Electromyography
(EMG): An EMG shows the electrical activity of the muscle during rest and during
muscle contraction. Examining the electrical activity may help a physician
identify any injury to the tibial nerve in the ankle
- Nerve
conduction velocity (NCV) study: Nerve conduction velocity study shows the
speed at which electrical signals move through a nerve. Slowing of nerve
conduction speed may indicate tibial nerve damage
Many
clinical conditions may have similar signs and symptoms. Your healthcare
provider may perform additional tests to rule out other clinical conditions to
arrive at a definitive diagnosis.
What are the possible
Complications of Tarsal Tunnel Syndrome?
If Tarsal
Tunnel Syndrome is properly treated, a high percentage of individuals usually
do not experience any serious complications. However, a common complication
associated with TTS includes a permanent injury to the tibial nerve. This can
result in:
- Permanent loss of strength of the ankle muscles
- Permanent loss of sensation in the ankle region
How is Tarsal Tunnel Syndrome Treated?
The treatment measures for Tarsal Tunnel
Syndrome include nonsurgical and surgical methods.
Nonsurgical treatment measures for Tarsal
Tunnel Syndrome include:
- Any activity that aggravates the ankle condition should be
avoided. The physician may advise the individual to refrain from participating
in any physical activities, till the pain or symptoms get better
- Application of ice/cold pack to the ankle, so as to reduce pain
and swelling
- Complete immobilization of the ankle with a cast may be required
to restrict movement
- Non-steroidal anti-inflammatory oral medications, such as
indomethacin and naproxen, may be used to treat Tarsal Tunnel Syndrome. These
medications can help decrease the pain and swelling
- Corticosteroid injections help provide temporary relief of
symptoms and in improving the range of motion. It is important to note that
corticosteroid injections only give temporary relief. Prolonged episodes of
such injections may injure the joints in the long run
- A well-fitted brace may help relieve pressure on the ankle for
individuals with flat feet or severe nerve damage
- A well-fitted ankle brace may help individuals with severe nerve
damage or flat feet to reduce the amount of pressure on the foot
- A well-padded custom-made shoe insert may be used to help the arch
and limit excessive motion that can cause nerve compression
- Physical therapy or ultrasound therapy may help decrease symptoms
Surgical treatment measures Tarsal Tunnel
Syndrome include:
- Tarsal Tunnel Syndrome Release: It is a minimally invasive
surgical procedure that allows a physician to examine certain structures within
the ankle, such as the laciniate ligament (a strong fibrous band in the foot),
using an orthopedic device (called an endoscope). During this procedure, the
laciniate ligament is cut, which decreases any abnormal pressure on the tibial
nerve, thereby reducing the signs and symptoms that the individual is
experiencing
How can Tarsal Tunnel Syndrome be Prevented?
Currently, there are no definitive methods
available to prevent Tarsal Tunnel Syndrome. However, certain measures that may
be helpful in preventing abnormal pressure on the tibial nerve include:
- Minimize participation in any sports or physical activities that
require repetitive overuse of the ankle; also learn the correct technique to
minimize stress
- Stretch before exercising or taking part in sports activities,
which can help prevent injuries to the structure around the nerve and decrease
the possibility of compression
- Wearing proper fitting and appropriate footwear, such as shoes
that provide an adequate cushion for the heel, may help reduce stress on the
ankle
- Perform exercises to strengthen the supporting muscles of the
lower leg, which can also decrease leg and ankle injuries
- Proper treatment of type I diabetes and type II diabetes can help
prevent TTS in such individuals
- Proper treatment of underlying conditions such as rheumatoid
arthritis (RA)
- Maintaining a healthy body weight can help reduce abnormal
pressure on the ankle joints
What is the Prognosis of Tarsal Tunnel Syndrome?
(Outcomes/Resolutions)
- Tarsal Tunnel Syndrome can range in severity from being a minor
condition to a serious and disabling condition
- The long-term prognosis of Tarsal Tunnel Syndrome is usually good
in a majority of the individuals
- If detected and treated early, signs and symptoms of TTS can be
controlled; in many instances, they may completely disappear
- If left untreated, severe cases of the disorder may result in
permanent muscle strength and sensation loss, leading to a decreased ability of
the individual to participate in any athletic, professional, or recreational
activity
Additional and Relevant Useful
Information for Tarsal Tunnel Syndrome:
Tarsal tunnel release (surgical procedure) decreases
the symptoms of Tarsal Tunnel Syndrome in about 85-90% of cases.
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