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.

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