Anything
that results in pressure on the Posterior Tibial Nerve can create Tarsal
Tunnel Syndrome. For some examples, direct trauma to the ankle can do
it, tendonitis of one of those tendons in the tunnel can cause it.
Varicose veins can cause it, as can any number of pathological growths
in the region. Tarsal Tunnel Syndrome seems to be more common with
diabetes or rheumatoid arthritis.
When abnormal
amounts of pressure develop inside the tunnel, the nerve, who's sole
reason for being is to feel things, does just that--it begins to feel that
pressure. And this is typically experienced by the patient as pain. This
is Tarsal Tunnel Syndrome.
What
are the symptoms of Tarsal Tunnel Syndrome?
There
may be numbness, sensitivity or pain in the area where the nerve is being
pinched, and in the areas of skin that the nerve would normally supply
sensation to, (which is most of the bottom of the foot). This is
often a burning, electrical, tingling, pins and needles type of pain.
Another
common symptom is weakness in the muscles supplied the nerve supplies.
Symptoms
are typically made worse by activity (which increases pressure in the Tarsal
Tunnel), and are usually
reduced
by rest,
though sometimes pain is severe at night.
How
is Tarsal Tunnel Syndrome diagnosed?
The
diagnosis of tarsal tunnel syndrome can often be made by a good patient
history and physical examination. Neurological testing in the
office is often all that's needed to make the diagnosis, though specialized
testing known as Nerve Conduction Studies can test how well impulses are being
carried up the nerve, and may be ordered. Magnetic
Resonance Imagine (MRI) may also be helpful in making the diagnosis.
How
is Tarsal Tunnel Syndrome treated?
To
a large degree, it depends upon what mechanism is causing the problem, but the
general aim is to decrease pressure on the nerve. Rest, ice, elevation,
anti-inflammatory medications, steroid injections, and physiotherapy may be
helpful. Custom-made, prescription, functional
orthoses
are usually
helpful to address any biomechanical abnormality that may be causing this
complaint (which his common). Avoiding tight stockings and shoes
may also provide relief.
Surgery
may be indicated, however, for difficult-to-resolve cases. This
surgery is usually done by decompressing the nerve, a procedure known as
"neurolysis".
The procedure entails freeing up the nerve from
any tissue that may be responsible for providing pressure to the nerve.
Local,
spinal or general anaesthesia may be used, though in most cases we prefer
to use local. Crutches are typically used post-operatively.