Tarsal tunnel syndrome (tarsal tunnel neuropathy) is medically defined as localized compression neuropathy of the posterior tibial nerve. This means that the nerve passing through the narrow bone-fibrous canal (tarsal tunnel) in the ankle joint is compressed, which leads to its ischemia (impaired blood supply), swelling and, ultimately, to impaired conduction of nerve impulses. Such dysfunction of the tibial nerve can cause unpleasant and painful symptoms, manifested by pain, discomfort, difficulty in walking and sensory disturbances in the ankle joint on the inner side of the foot. These manifestations can ruin more than one person's life.
Illinois Foot & Ankle Clinic offers patients state-of-the-art diagnostic and treatment methods. Our leading specialist Dr. Alex Yanovskiy, DPM, has many years of experience in diagnosing and treating tarsal tunnel syndrome and is ready to help his patients regain comfort and pain-free foot mobility.
Types of Tarsal Tunnel Syndrome
Tarsal neuropathy can manifest itself in various forms that vary in severity (mild, moderate, severe) and duration of symptoms. Each of these conditions can manifest in both acute and chronic forms, which requires a special approach to diagnosis and treatment.
- Acute form. Develops suddenly with rapid progression and pronounced pathological symptomatology (sharp pain, tingling and numbness in the foot). These symptoms may be caused by trauma, such as a broken bone or sprained ligaments that put pressure on the nerve in the tarsal tunnel, result from inflammatory processes caused by infections or autoimmune diseases. May be temporary if the cause is treated (after the injury heals or inflammation is relieved). The acute form usually lasts a short time, from a few days to a few weeks.
- The chronic form. It is characterized by a slow development with a gradual increase in symptoms. Patients may experience a constant sensation of “needles”, numbness and tingling in the foot, which increases with exertion (prolonged walking or standing). The chronic form can be caused by prolonged exposure of the nerve, such as from constant pressure from shoes, anatomical features of the foot, or diseases such as diabetes that cause nerve damage. Over time, if left untreated, symptoms can become increasingly severe. The chronic form of the disease can last for months, years, and sometimes a lifetime.
Regardless of whether the condition is acute or chronic, only timely treatment can improve the condition and restore freedom of movement.
Causes of Tarsal Tunnel Syndrome
Many causes can trigger the development of the disease, which contributes to the development of nerve compression:
- Trauma to the foot and ankle (fractures, dislocations or sprains).
- Inflammatory background diseases (various forms of arthritis, tendonitis and autoimmune diseases).
- Varicose veins
- Varus or valgus pathology
- Flat feet
- Obesity
- Diabetes
- Development of osteophytes and tumors in the tarsal canal.
In order to restore the normal functioning of the foot, it is important to identify and eliminate the root cause of the disease in a timely manner.
Symptoms and Signs
Patellar symptoms occur as a consequence of nerve compression in the tarsal canal area, located on the inside of the ankle.
The main signs of the syndrome are as follows:
- Pain: may spread to the heel, arch of the foot or even to the toes. It increases with prolonged walking, running, standing or wearing tight shoes. At rest, the pain may decrease.
- Paresthesias: burning and tingling sensation in the feet, ankle and fingers (like the presence of pins and needles in the feet).
- Decreased sensation: numbness and tingling in the feet, decreased sensation in the heel and fingers.
- Muscle weakness: sometimes there may be weakness in the muscles of the foot, resulting in a change in gait or difficulty walking.
- Swelling and inflammation: increased nerve compression leads to swelling and inflammation in the ankle area.
If you notice tingling, numbness or pain in your foot, especially if these symptoms become frequent or intense, it's time to see a specialist. The longer the nerve remains compressed, the more likely it is that the damage will become permanent.
Diagnostics: Understanding the Condition
At Illinois Foot & Ankle Clinic, we utilize examination and diagnostic techniques to accurately determine the presence of tarsal tunnel syndrome and the severity of the condition, allowing us to choose the best treatment plan.
Physical Examination
- History: identifying the nature, localization and intensity of pain, what triggers it and what helps to relieve it.
- Palpation: palpation of the tarsal canal area to determine if it is painful, thickened or swollen.
- Neurological examination: checking the sensitivity of the skin of the foot, muscle strength, tendon reflexes.
- Provocative tests: special tests to reproduce the symptoms of the disease - tapping on the course of the nerve (Tinel's symptom) or flexion of the foot (Goldberg's symptom).
Instrumental methods of research may include:
- Electroneuromyography
- Ultrasound
- MRI
- Radiography
It is a comprehensive approach to diagnosis, and the totality of the data obtained during the examination of the patient, allows you to establish an accurate diagnosis.
Treatment Options for Tarsal Tunnel Syndrome
Treatment for tarsal tunnel syndrome depends on the cause of the foot numbness, the severity of the symptoms, and the degree of nerve compression. At Illinois Foot & Ankle Clinic, Dr. Alex Yanovskiy, DPM and his team offer an individualized and comprehensive treatment approach to help patients regain mobility and get rid of pain.
Conservative treatment methods
Orthopedic insoles and supportive shoes
- Special insoles help to maintain the correct position of the foot by reducing pressure on the nerve in the tarsal tunnel.
- Properly fitting shoes with good cushioning and support for the arch of the foot significantly reduces the severity of symptoms and prevents them from worsening.
Physical Therapy
- Special exercises help to strengthen the muscles of the foot and lower leg, improving blood circulation and reducing pressure on the nerve.
- Stretching and tissue mobilization techniques may be used to reduce inflammation and relieve pain.
Drug therapy
- To reduce pain and inflammation, non-steroidal anti-inflammatory drugs are prescribed.
- For local anesthesia - lidocaine in the form of ointments or patches.
- In cases of severe inflammation, the doctor may recommend injections of corticosteroids, which help to quickly relieve swelling and reduce pressure on the nerve.
Immobilization
In some cases, it may be necessary to temporarily immobilize the foot and ankle with an orthosis or plaster cast. This helps to reduce pressure on the nerve and reduce symptoms.
Surgical treatment
If conservative methods do not provide relief or the nerve compression becomes too severe, surgical intervention may be required.
Nerve decompression
The main goal is to relieve pressure on the tibial nerve. The surgeon makes an incision in the ankle area to free the nerve from the tissues that are compressing it. This may include removing thickened ligaments or removing a cyst if it is the cause of the compression. The surgery is performed under local or general anesthesia.
After surgery, a special rehabilitation program is developed for the patient, including physical therapy and gradually increasing the load on the foot. This helps to speed up recovery and prevent recurrence of the syndrome.
Dr. Alex Yanovskiy, DPM at Illinois Foot & Ankle Clinic will help you understand the cause of your symptoms and offer the most effective treatment to restore comfort and ease of movement.