Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is a condition that usually affects the medial (inside) of the ankle. There are many structures that run through this area, including tendons, veins, arteries and nerves.
Tarsal Tunnel Syndrome occurs when the posterior tibial nerve, as it courses under the ligament at the ankle, becomes inflamed for a variety of reasons, namely: excessive pronation, arthritic problems such as rheumatoid arthritis, trauma, and even obesity.The symptoms include tingling, burning, numbness and vague aching and pain on the inside of the ankle radiating down to the arch of the foot.

The diagnosis of this condition is made by specific palpation over the nerve that is very uncomfortable and sensitive. Frequently, a Nerve Conduction Test, which measures the electrical conduction of the nerve over the ankle, is performed to confirm the diagnosis.

Treatment of Tarsal Tunnel Syndrome includes rest, physical therapy treatments and medication. Rest entails immobilization of the ankle in a brace, boot or a cast. In certain conditions aggravated by an excessive flat foot or pronation of the foot, an orthotic arch support is helpful. Sedative medications that decrease the electrical activity of the nerve are frequently prescribed.

If these treatments do not relieve symptoms, surgery (Tarsal Tunnel Release) may be performed. An incision is made behind the ankle and a ligament that compresses the nerve is released. This decreases the pressure on the nerve by the overlying ligament. Following surgery a removable boot is worn for approximately four weeks. Physical therapy will decrease the swelling and scarring over the nerve.