Tarsal Tunnel Syndrome: Signs, Causes and Treatments
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The tarsal tunnel syndrome is a condition that can significantly affect your quality of life. This syndrome is characterized by compression of the posterior tibial nerve, causing pain, sensory disturbances, and cramps in the foot.
Signs and symptoms of tarsal tunnel syndrome
Tarsal tunnel syndrome is a condition that can significantly impact quality of life. It is therefore essential to understand its signs and symptoms for early diagnosis.
Common signs
The common signs of tarsal tunnel syndrome are generally subtle at first. They may include a tingling or burning sensation in the foot, especially in the toes and the sole of the foot. A dull or throbbing pain may also be felt, often worsened by physical activity. It is important to note that these signs may vary from person to person.
Plantar fasciitis is frequently associated. The diagnosis is often made in cases of plantar fasciitis resistant to well-managed medical treatment. If treatment for plantar fasciitis fails, tarsal tunnel syndrome should be considered.
Advanced symptoms
As tarsal tunnel syndrome progresses, the symptoms can become more severe. The pain may intensify, sometimes becoming so intense that it disrupts sleep. Sensations of weakness or heaviness in the foot may also appear, making it difficult to perform daily activities. In the most advanced cases, a loss of sensation or paralysis of the foot muscles may occur.
Causes of tarsal tunnel syndrome
Common causes
The causes of tarsal tunnel syndrome can be varied. They may include an anatomical cause, such as a bone, a cyst, or varicose veins, that put pressure on the posterior tibial nerve. Injuries to the foot or ankle, inflammation, or even osteoarthritis can also lead to this syndrome.
Risk factors
Certain risk factors may increase the likelihood of developing this syndrome. For example, people who engage in intense or repetitive physical activity, those who wear shoes unsuitable for their chosen physical activity. Additionally, people with certain diseases, such as diabetes, may also be at higher risk.
It is important to make the diagnosis early because the longer the nerve compression lasts, the greater the risk of long-term effects in the event of surgical nerve decompression.
Diagnosis of tarsal tunnel syndrome
Diagnostic Elements
The diagnosis of tarsal tunnel syndrome begins with a specialized consultation. We take the time to thoroughly examine your symptoms and medical history. The clinical examination is important; it is necessary to analyze the patient's gait and to characterize the morphology of the foot, while ruling out other conditions such as compartment syndrome which may present similar symptoms. There are maneuvers that make it possible to detect irritation of the posterior tibial nerve and potentially of each of its three branches.
Tests and Examinations
The diagnosis of tarsal tunnel syndrome is clinical. Electromyography is used to confirm the diagnosis and also to assess the prognosis in case of treatment. Electromyography may detect signs of nerve damage, signs of denervation, related to prolonged compression or chronic suffering of the posterior tibial nerve.
We systematically perform a radiological assessment of the ankles under load to look for any potentially compressive bony elements.
An MRI of the ankle is also systematically performed to search for other compressive elements such as cysts or lipomas. It also allows us to look for varicose veins that could potentially be responsible for compression of the posterior tibial nerve in its inextensible fibrous tunnel.
Medical treatments for tarsal tunnel syndrome
Non-surgical treatments are mainly aimed at reducing inflammation and pain. They may include physical therapy exercises, the use of orthopedic insoles or modifying daily activities to avoid movements that aggravate the pain.
Stretching exercises of the posterior muscle chains, as done for plantar fasciitis, can be very effective on symptoms.
Medications
Medications can also be prescribed to manage the symptoms of tarsal tunnel syndrome. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to reduce inflammation and pain.
Analgesics that act specifically on neuropathic pain may be used. The prescription of these particular painkillers should be supervised by a doctor experienced in prescribing this type of treatment.
Tarsal tunnel surgery
Surgery for tarsal tunnel syndrome is an option we consider when other treatments have not provided the expected relief, or when there is evidence of nerve compression on the electromyogram.
When is surgery necessary?
Surgery is generally necessary when tarsal tunnel syndrome is severe or when non-surgical treatments have not produced satisfactory results.
Types of surgery
There are different types of surgery to treat tarsal tunnel syndrome. Decompressive surgery, for example, aims to release the tibial nerve by opening the tarsal tunnel. It is also necessary to treat all potentially compressive elements during the procedure.
In some cases, factors that favor or worsen tarsal tunnel syndrome can be treated at the same time. A flat foot with a large valgus of the hindfoot may require corrective surgery of the hindfoot alignment, or even flat foot correction, to relieve tension on the posterior tibial nerve.
Recovery
Recovery after tarsal tunnel surgery depends on several factors, including the type of surgery performed.
In cases of decompression surgery, all anatomical layers are opened including the tarsal tunnel, and only the skin is closed at the end of the operation. To protect the skin, a plaster cast immobilization is performed for three weeks postoperatively.
Conclusion
Tarsal tunnel syndrome, although rare, requires early diagnosis. An electromyogram, ankle X-rays, and an MRI of the ankle should systematically be performed to characterize tarsal tunnel syndrome, determine its severity, and look for potentially compressive elements of the posterior tibial nerve.
In cases of electromyographic distress of the posterior tibial nerve, it is necessary to perform nerve decompression surgery, or even realignment, to limit the risk of residual nerve damage.