TARSAL TUNNEL SYNDROME
Tarsal tunnel syndrome is a nerve compression disorder in the ankle. You may be familiar with carpel tunnel syndrome in the wrist and these are very similar. The tarsal tunnel is a pathway for tendons, nerves, arteries and veins to enter the foot. These structures originate in the leg and make a turn at the level of the ankle to enter the foot. If you feel the bone on the inside of the ankle and bring your fingers just behind that bone you are at the tarsal tunnel. Each structure: the tendons, nerve, artery and veins are in different compartments. Essentially the nerve in the tunnel gets compressed. When there is compression or pressure against the nerve in its compartment it causes a burning, shooting, stabbing and painful problem that extend upwards into the leg or travel down into the foot along the nerve pathway. Causes of tarsal tunnel syndrome can include Varicose veins, tendinitis, soft tissue adhesions and narrowed openings for the nerve to traverse, trauma, abnormal stresses from a foot or ankle disorder, to name a few. Tarsal tunnel must be differentiated from plantar fasciitis. See article
The main and largest nerve In the tarsal is called the posterior tibial nerve( PTN). Towards the end of the tunnel the PTN branches and divides. The various branches innervate various structures on the bottom of the foot such as muscles and the skin. These branches may also get compressed and cause nerve pain. Although TTS is the most common, other nerves can become compressed with similar treatment options. These nerves include the common perineal nerve, superficial perineal nerve, anterior tibial nerve.
Treatments for TTS include conservative and surgical care. First it is important to identify why the TTN syndrome is present. For example, if the syndrome is caused by a tendinitis, we will first treat the tendinitis and the TTS will subside. Oral medication, CBD oil (medical marijuana), amion injection (stem cell) therapy, and physical therapy includes Tens unit therapy are all conservative options. If this does not resolve the problem, surgical care includes relieving the compression through a nerve decompression procedure. It is imperative that all of the nerves in the tarsals tunnel and into the foot are released and freed from its surrounding tissue. The post procedure recovery is quite quick with early weight bearing and therapy. Patients typically have resolution of symptoms within three weeks and return to activity within four to six weeks.