For being such a crucial part of the body, the human ankle is actually a very simple structure, containing only three main bones that create the very joint that allows you to walk, run and dance. Despite its simplicity, it is also one of the easiest areas to hurt, with ankle sprains accounting for nearly two million injuries reported to podiatrists in America each year. A small number of ankle injuries, however, aren’t sprains at all, but instead a more serious issue known as tarsal tunnel syndrome. We’ll be exploring this rare condition in greater detail, namely what it is, what causes it, and what you can do if you suspect that you’re being affected by it.
What Is Tarsal Tunnel Syndrome?
Let’s first explore the area that tarsal tunnel syndrome affects; the ankle, and more specifically, the aptly named tarsal tunnel. Due to its complexity, podiatrists divide the foot into three areas for the sake of easy conversation: The forefoot, the midfoot and the hind foot. The hindfoot, where we’ll be focusing, consists of the heel and ankle bones. On the inside of your ankle lies the tibia, which is attached to your heel via the flexor retinaculum, a thick band of ligaments. Together, these form a sort of channel, through which runs nerves, veins and arteries. One of these nerves, the tibial nerve, can become pinched with repeated pressure from various sources. Over time, this damages the nerve and results in severe pain, pins and needles or even loss of sensation in the foot.
What Causes This Painful Foot Condition?
You develop tarsal tunnel syndrome when the tibial nerve comes under constant compression, but this tends to be caused by other ailments such as:
Flat feet that stretch the tibial nerve.
Benign bony growths in around the tarsal tunnel.
Inflammation from arthritis in the area.
Varicose veins that develop in the membrane that surrounds the tibial nerve.
Tumors or lipomas near the tibial nerve.
Injuries such as an ankle sprain or fracture that causes swelling and inflammation in the area.
Over use of the foot or ankle most commonly caused by exercising, standing, running, or prolonged walking.
How Is TTS Diagnosed?
If you believe that you have tarsal tunnel syndrome, it is important to visit with a podiatrist or foot doctor so they can help identify the cause of the TTS and create a treatment plan with you so that the condition doesn’t become worse. While you can visit a general practitioner for some advice, it is better to book an appointment with us, your local podiatrist located in Des Moines or an orthopedic surgeon.
At your appointment with an ankle doctor, they will ask about the symptoms you are experiencing and how your symptoms progressed. They will then ask to examine your foot and ankle, looking for key physical characteristics that indicate tarsal tunnel syndrome. One of the tests they may run is called a Tinel Test, where the podiatrist simply taps on the tibial nerve to see if you experience a tingling sensation or pain.
If your foot doctor does suspect tarsal tunnel syndrome, they may order additional tests such as an electromyography which looks for nerve dysfunction or a magnetic resonance imaging (MRI) if they believe that a bony growth could be the cause of the condition. You may be also asked to stay for an x-ray or for a nerve conduction velocity test (EMG).
How Is Tarsal Tunnel Syndrome Treated?
At the first sign of symptoms, you should have a foot doctor assess your foot and ankle for TTS as there are several options for treatment, especially if it is a minor case of TTS. The most common treatment options include using RICE - rest, ice, compression, and elevation in combination with non-steroidal anti-inflammatory medications. However, if you have a severe case of TTS, aggressive treatment options do exist.
l Rest is the first line of defense. This will reduce inflammation and pressure on the nerve. You may need to replace high-impact exercises like running with low-impact ones like swimming. In severe cases, you may need to refrain from exercise completely.
RICE is next. Use rest in combination with ice to reduce inflammation and compression/elevation to reduce blood flow to the area.
Use full immobilization if there is physical damage done to the nerve. This will give the nerve a change to heal.
Injection therapy can be used for very painful bouts of TTS. This will put local anesthetics or corticosteroids directly into the nerve to provide relief.
Your podiatrist may recommend orthopedic shoes or correct devices that help limit motion around the nerve and provide support to your foot’s arch. This can also help prevent your foot from rolling inward.
Physical therapy can also be used to stretch and strengthen the connective tissues, mobilize the tibial nerve and open up the joint space around it to reduce compression. This can be combined with acupuncture, manual therapy, taping and bracing, or even ultrasound therapy.
Foot exercises should be done to help prevent the worsening of symptoms. These can include: ankle pumps, ankle circles, heel-toe raises, pencil toe lifts, balance exercises, plantar fascia stretch, gastrocnemius stretch, and the soleus muscle stretch.
Are There Any Complications With This Condition?
In that tarsal tunnel syndrome is very similar to carpal tunnel syndrome, in that the nerve is being squeezed in such a narrow and confined space, there are some complications that can come with this condition. It tends to cause pain on both the inside of the ankle and the bottom of the foot, and it may impact both your lower leg and toes.You may experience tingling, burning, searing or shooting pain, numbing, a weakened ability to flex or bend your toes, as well as loss of sensation in the toes, sides and bottoms of the affected foot.