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Tarsal Tunnel Syndrome
Tarsal Tunnel Syndrome occurs from excess pressure on the tibial nerve.The tibial nerve curves back and forth from the ankle up the back of the leg. There are four sections on the lower limb that the tibial nerve passes through. In three compartments, the muscles connect the leg to the foot. In the 4th, the tibial artery and tibial nerve are surrounded by muscles. At the top of these compartments is the lacinate ligament, which covers the compartments. The tibial nerve nerve must have sufficient space in the area, free of entrapment, for complete functioning of the foot. If the cavity housing the tibial nerve is pressed upon, entrapment happens.
When entrapment occurs, the patient may lose sensation in the foot, and feel numbness and pain. The pain may increase during and towards the end of the day. Tarsal tunnel symptoms may sometimes be relieved by elevating the feet, respite and massage therapy.
Tarsal nerve entrapment has been observed for all age groups, but most often in adults. The burning sensation from the foot is the nerve attempting to send signals to the brain with partial blockage. When compressed by the surrounding muscles on other tissues, the restriction causes the burning and tingling sensations. Common causes of compression are adjacent muscles around the nerve growing too much. Other impingements may include cysts in the area, systemic disorders like diabetes and rheumatoid arthritis.
Traumatic injuries like stress fractures may also lie at the cause. After a traumatic injury, healing occurs, and fibrous tissue forms, similar to a scar. If too much fibrous tissue forms, it can flow into the tarsal tunnel and push on the nerve.
Treatment options include wide shoes, arch supports, ibuprofen and other medications that reduce inflammation and orthotics.
If the more conservative methods fail, a physician may apply cortisone injections. If all conservative treatments are unsuccessful, surgery may be suggested to increase the space in the nerve cavity to reduce compression. Successful surgery will create sufficient space for the nerve, free of impingement.
