Tarsal Tunnel Syndrome
1. What is it?
Tarsal tunnel syndrome refers to a condition where the posterior tibial nerve becomes compressed. The nerve travels past the medial (inside) aspect of the ankle where it goes through a fibrous canal. It supplies the bottom of the foot with sensation and provides nerve input for plantar flexion (toe pointing) and inversion of the foot.
2. What are the causes/predisposing factors of injury?
Anything that can compress the nerve along its path can create this condition. Overpronation of the ankle can cause the condition, as well as inflammation of any tendons or blood vessels in the area. Inflammatory arthritis may also be a cause.
3. What are the symptoms?
Usually symptoms are a burning or tingling sensation in and around the ankle, which can also be felt on the sole of the foot up to the toes. There may also be difficulty with standing or walking or with various types of shoes. Symptoms tend to be worse with activity and better with rest.
4. What can be done to prevent or treat this injury?
Prevention is focused on proper biomechanics and muscle balance. If there are biomechanical issues such as abnormal foot movement, then proper footwear and/or orthotics may be indicated. If there is excessive tightness or weakness of any of the muscle groups in the lower leg, this must be addressed.
Treatment is generally conservative. Relative rest, anti inflammatories, orthotics, soft tissue work, physical therapy modalities and joint mobilization can be used. If the condition is non responsive to conservative care, surgery is an option.