The foot is subjected to forces way beyond the body weight can support on a daily basis. The ankle is a complex structure that is responsible for bearing weight. If an individual has tarsal tunnel syndrome, it involves compression of the nerve inside the tunnel. The pressure can be due to injuries that result to deformities, tumors, inflammation of the protective sheath or impingement on the nerve. Remember that the compression on the nerve can disrupt the signals transmitted through the nerve, resulting to pain and other neuropathy in the foot.
Causes of tarsal tunnel syndrome
There are various causes and in some cases, the doctor might not be able to determine the exact cause. Individuals who have flat feet can develop this condition due to the strain placed on the structures of the feet and changes in the course of the tendons and nerves into the feet, thus adding pressure on the tibial nerve. A tumor or cyst in the area can also generate pressure on the nerve.
Systemic diseases such as diabetes or rheumatoid arthritis can also cause or increase the risk for this condition. The joint inflammation by arthritis will reduce the space for the nerve, thus increasing the pressure.
Those who are overweight or obese might be prone to this condition due to the excessive pressure placed on the posterior tibial nerve.
Injuries to the ankle caused by swelling in and around the joint can also add pressure on the tibial nerve. Dislocations or fractures can cause the tunnel to move slightly or close up.
What are the signs and symptoms?
Pain, burning or tingling along the interior of the ankle and down into the foot can occur. The pain can vary from prickling point in the foot to severe burning pain on the entire foot and ankle area. The pain worsens with activity particularly extended walking or standing and tends to improve with rest.
There is also pain upon palpation of the nerve. Loss of sensation can be experienced by the individual if the condition is allowed to progress. In addition, a change in the gait can also occur if not treated promptly.
The symptoms can occur abruptly, but can worsen by prolonged periods of activity. The initial signs of pain are often ignored and the condition is allowed to progress until the nerve is compromised severely.
Treatment
Tarsal tunnel syndrome is managed with rest (to minimize the swelling), immobilization (to allow the nerve and surrounding tissues to heal) and NSAIDs (to minimize pain and inflammation). Physical therapy is also started as well. Ultrasound and other therapies can also be used to hasten the healing process.
In cases where the inflammation and pain are difficult to manage, an injection of a local anesthetic and corticosteroid are beneficial. In some cases, bracing is applied in severe cases to minimize the pressure on the foot and on the nerve.
Surgical intervention might be required in severe cases or those that do not respond to non-surgical interventions. This typically involves decompression of the nerve by releasing the ligament around it, repairing the structures in the tunnel or clearing the obstruction.