Tarsal Tunnel Syndrome: diagnosing & treating posterior tibial neuralgia

In this video we explain tarsal tunnel syndrome's causes, symptoms and treatment options.

The tarsal tunnel in the ankle is the equivalent of the carpal tunnel in the wrist. It's located inside the ankle next to the ankle bones.

It's job is to protect veins, arteries, tendons and nerves, one of these being the posterior tibial nerve.  When this nerve is squeezed, or compressed, it results in a condition called tarsal tunnel syndrome (TTS).

Accurate diagnosis of tarsal tunnel is crucial to stopping further damage. With decades of experience armed with state-of-the-art testing techniques we can ensure a pinpoint diagnosis.

What are the symptoms of Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome Treatments

Many patients experience a tingling or burning sensation inside the ankle or in the sole of the foot while others experience pain in the ankle, heel, toes, arch, and even up the calf.

 

It is very important to seek proper medical care at the early onset of tarsal tunnel syndrome symptoms. If the condition is left untreated and progresses, it may result in permanent nerve damage.

 

 

The treatments for Tarsal Tunnel Syndrome

University Foot and Ankle Institute has the latest testing equipment available for the most accurate diagnosis. Testing methodologies to diagnose the extent of nerve compression include neurosensory testing, ultrasound, x-rays and MRI. 

 

Conservative Treatment for tarsal tunnel syndrome

If compression is minimal, your physician may attempt conservative care, such as physical therapy, custom orthotics or braces, rest and casting. If these less-invasive methods fail to solve the compression, your doctor may suggest surgical intervention.

 

tarsal tunnel syndrome surgery

Tarsal tunnel syndrome surgery should only be considered if all non-operative treatment options have been unsuccessful at relieving pain and other symptoms. Tarsal tunnel surgery is conducted to relieve pressure on the posterior tibial nerve and its branches.

 

To decompress the nerve in the tarsal tunnel, an incision is made behind the ankle bone and toward the bottom of foot. The posterior tibial nerve is separated from the artery and vein and then followed into the tunnel. The nerves are then released. Your doctor will also look for cysts and other nerve-blockage problems that may need correction. If there is scarring within the nerve or branches, the outer layer of nerve wrapping is opened and scar tissue removed.     

 

We utilize the state-of-the Medtronic intraoperative nerve-testing machine at the time of tarsal tunnel release. Testing ensures that compression is caught and removed.

 

This intra-operative testing is only available in select locations in the United States including University Foot and Ankle Institute. 


What to expect post-surgery
 

During surgery a bulky dressing is applied to the foot to keep the leg from moving and minimize swelling in case of weight bearing. The dressing typically remains on for about a week. Most people use crutches for the first three weeks. Heavier or older patients may use a walker.

 

Sutures are left on for three weeks for skin to regain 90 percent of its original strength. We want the nerves to glide post-operatively, so it is critical during the 2nd and 3rd weeks following the surgery that the posterior tibial nerve and its branches are able to move in the tunnels. An air cast is applied so the ankle has some range of motion and toe movement so the nerves do not become adherent to the surrounding tissue.

  • ZocDoc
    Dr. Yau is very compassionate, soft spoken and easy to talk to. He answers all your questions.
    Vriginia B.
  • CustomerSure
    I appreciate Dr. Bavarian's super-quick responses to my email questions!
    Marylyn T.
  • Yelp
    I recently tore my CFL, got an MRI and was recommended surgery by my doctor in Northern California. After doing some of my own research, I came across this article - A Guide to Treating Ankle Sprains from Start to Fin...
    Wudan D.
  • Yelp
    Dr. Franson and the entire staff at University Foot & Ankle Institute - Valencia are awesome!! I had both feet corrected (bunion surgery) by Dr. Franson and he did amazing work!! He is caring, gentle and friendly, and...
    Helena O.
  • CustomerSure
    I really appreciate the office flexibility, as I never know when my foot issue will flare up and I will need to be seen. It is unpredictable, so I am grateful that the staff works to get me in to see Dr Briskin!
    Nancy S.
  • Yelp
    I was treated by Dr. Franson last summer after waking up to a debilitating ankle pain. I had been to several doctors in the weeks leading up to Dr. Franson's office visit with no real diagnosis or treatment. Dr. Fra...
    Ecole L.
  • CustomerSure
    We love Dr. Franson & staff!
    Michael M.
  • Yelp
    Dr. Baravarian took care of my very painful hung nail last year and I have had no problems since then. I since recommended 3 friends to him for different problems/surgeries and they are all so thankful and happy with ...
    Haleh S.
  • CustomerSure
    I have always enjoyed my experiences here. A very warm and friendly atmosphere.
    Sa W.
  • Yelp
    I used to suffer from bunions for as long as i can remember. I danced ballet for 17 years, love wearing heels, and both my parents have bunions, so my bunions were REALLY painful. I researched the best podiatrist and ...
    B.E.
Same day appointments now available!
or call 24/7:
  • University Foot & Ankle, a Preferred Provider to:
  • UCLA Health System - UCLA Medical Group
  • MPTF - Member Industry Health Network
  • Cirque du Soleil
  • ATP - Association of Tennis Professionals
  • And consulting physicians for:
  • C&S - Cedars-Sinai
  • Saint John's Health Center