Tarsal Tunnel Syndrome

Tarsal tunnel syndrome (TTS) is a condition characterized by compression or irritation of the tibial nerve as it passes through the tarsal tunnel, a narrow space on the inside of the ankle. This compression leads to pain, tingling, numbness, and weakness in the ankle and foot.  Early diagnosis and appropriate management are crucial for minimizing symptoms and preventing long-term complications.

Causes

Several factors can contribute to the development of TTS, including:

• Ganglion Cysts: These fluid-filled sacs develop near joints or tendons.  When a ganglion cyst forms within or near the tarsal tunnel, it can exert pressure on the tibial nerve.
• Anatomical variations: Flat feet, bone spurs, or varicose veins can increase pressure on the tibial nerve.
• Injuries: Trauma to the ankle, such as sprains or fractures, can cause inflammation and compression of the nerve.
• Systemic conditions: Diabetes, arthritis, or hypothyroidism can predispose individuals to nerve compression.
• Overuse: Repetitive activities that involve the foot and ankle, such as running or standing for extended periods, can lead to inflammation and compression of the nerve.

Symptoms

Common symptoms of TTS include:

• Pain: Sharp or burning pain along the inner side of the ankle and sole of the foot.
• Tingling and numbness: Sensations of pins and needles or loss of sensation in the toes and sole.
• Weakness: Difficulty in lifting the toes or maintaining balance.
• Swelling: Inflammation around the ankle and foot.

Non-Surgical Treatments

• Rest and Activity Modification: Avoiding activities that exacerbate symptoms and incorporating rest periods can alleviate pressure on the nerve.
• Physical Therapy: Stretching and strengthening exercises can improve ankle stability and reduce compression on the tibial nerve.
• Orthotic Devices: Custom orthotic inserts or supportive footwear can correct biomechanical issues and relieve pressure on the nerve.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections may help reduce inflammation and alleviate pain.

Surgical Treatments

If conservative measures fail to provide relief, surgical intervention may be necessary. Surgical options include:

• Tarsal Tunnel Release: This procedure involves decompressing the tibial nerve by releasing the ligaments and other structures that constrict the tarsal tunnel.
• Nerve Decompression: Surgeons may also remove any adjacent structures, such as cysts or bone spurs, contributing to nerve compression.

Prevention

While TTS may not always be preventable, individuals can reduce their risk by:

• Wearing Proper Footwear: Supportive shoes with cushioning and arch support can minimize stress on the feet and ankles.
• Maintaining Healthy Weight: Excess weight can increase pressure on the tibial nerve, so maintaining a healthy weight reduces the risk of compression.
• Stretching and Strengthening Exercises: Regular stretching and strengthening exercises for the ankles and feet can improve flexibility and prevent overuse injuries.
• Avoiding Overuse: Moderating activities that strain the feet and ankles, such as prolonged standing or high-impact exercises, can prevent nerve compression.