Tarsal Tunnel Syndrome
Well, most of us have heard of carpel tunnel. Tarsal tunnel syndrome is the same but the problem is in the foot. Like both syndromes, the problem is an entrapment of a nerve in a tunnel, which is just a path for that nerve. The nerve gets so enlarged that it causes pressure in this tight tunnel. Just think of a traffic jam inside the Lincoln Tunnel. Your car represents the nerve. The increase amount of cars inside the tunnel will cause congestion. That is what is happening to the nerve. It is congested.
The tarsal tunnel is located on the inside of the ankle. The nerve in that area is called the Posterior Tibial Nerve. This nerve then sends off numerous branches to the inside and outside of the heel, and to the majority of the foot. Due to this, it is hard to initially distinguish between heel pain caused by plantar fasciitis or by tarsal tunnel syndrome. In some cases, you can have both. This happens when the plantar fasciitis pain lingers too long, thus causing abnormalities of gait, leading to excessive pressure of the tarsal tunnel area.
However, with proper physical examination, a podiatrist can distinguish between the two problems. Your doctor will tap the area of the tarsal tunnel. If you have a stinging, tingling sensation that radiates up or down the ankle, then your nerve is inflamed. Plantar fasciitis pain is more of a sharp, achy feeling that is located on the bottom or side of the heel when pressure is applied.
CAUSES OF TARSAL TUNNEL SYNDROME
So, what causes tarsal tunnel syndrome? The biggest cause is biomechanical, meaning the way the foot functions in gait. If you are reading about foot problems, you will find the common denominator of most pedal issues to be from poor biomechanics. Our feet get a lot of abuse, especially if you have a few extra pounds on you. Again the culprit is over-pronation, which means the heels are turning outward or the ankles are turning toward one another. This will cause tension along the tarsal tunnel area.
Another cause are varicose veins. The veins wrap around the nerve, leading to inflammation on this structure. In addition, anything that causes excessive pressure on that nerve will lead to this pain, such as a cyst, or lymphedema. An injury to the ankle or thickening of an adjacent muscle will definitely put more pressure on the tarsal tunnel. Another culprit is back pain. A disc problem can lead to pressure on a nerve that sends a signal of pain to the foot and ankle.
Your doctor will diagnose the problem with physical examination, x-rays, and possibly nerve testing, however that is a good chance of a false-negative result in this area, meaning if the test is not very accurate.
TREATMENT
The earlier the condition is diagnosed, the faster the problem gets resolved. Nerves can take a long time to heal, so it is best to get treated quickly. Treatment consists of steroid injections, strapping and custom orthotics. Orthotics treat the biomechanical faults of the foot, thus relieving pressure off the nerve. Anti-inflammatories and physical therapy are also additional treatments. The goal of physical therapy is reduce the swelling the tunnel area and to strengthen the foot in general. If these treatments are not successful, then cryosurgery is an excellent option. The foot is anesthetized, and then a small incision, the size of a paper-cut, is made on the inside of the ankle. A probe is placed in the area that sends liquid nitrous oxide into the surrounding the nerves. This will decrease the inflammation of the nerve and within 6-8 weeks the nerve will begin to regenerate and heal. The patient can walk immediately afterwards in their own walking shoe. There are no stitches, just a band-aid. Learn more about cryosurgery by going to:
http://www.stopfootpainfast.com/library/cryotherapy.cfm.
The last resort would be an open surgery. Surgical intervention involves releasing of any tight structures surrounding the nerve, and/or removing any of the space occupying lesions.
Don’t wait too long to get treated. Remember, nerves heal slowly.
