Tarsal tunnel syndrome

Tarsal tunnel syndrome is a painful foot condition in which the tibial nerve is impinged and compressed as it travels though the tarsal tunnel. Patients complain typically of numbness in the foot, radiating to the big toe and the first 3 toes, paining, burning, electrical sensations, and tingling over the base of the foot and the heel. Depending on the area of entrapment other areas can be affected. If the entrapment is high, the entire foot can be affected as varying branches of the tibial nerve can become involved. Ankle pain is also present in patients who have high level entrapments. more...

Diagnosis is typically made by a podiatrist, neurologist, or orthopedist. Patients report of their pain and a positive tinel's sign are the first steps in evaluating the possibility of tarsal tunnel syndrome. An MRI and nerve conduction studies are common. Common causes are neuropathy and space occupying anomalies within the tarsal tunnel. Varicose veins within the tunnel are a common cause.

If non-invasive treatment measures fail, surgery may be recommended to decompress the area.

Treatments typically include rest, casting with a walker boot, corticosteriod and anesthetic injections, hot wax baths, wrapping, compression hose, and orthotics. Medications may include various anti-inflamatories, anaprox, ultracet, and Neurontin. Lidocaine patches are also a treatment that helps some patients.

In severe cases the patient may not respond and need surgical treatment. Recovery time is weeks to months, and many patients report good results. Some, however, experience no improvement or a worsening of symptoms. In the Pfeiffer article (Los Angeles, 1996), less than 50% of the patients reported improvement, and there was a 13 % complication rate. This is a staggering percentage of complications for what is a fairly superficial and minor surgical procedure.

Pfeiffer WH, Cracchiolo A 3rd. University of California, Los Angeles Medical Center. "We reviewed the clinical results for thirty patients (thirty-two feet) who had had exploration and decompression of the posterior tibial nerve for the treatment of tarsal tunnel syndrome between 1982 and 1990. The average duration of follow-up was thirty-one months (range, twenty-four to 118 months). Most of the patients were female, and the average age was forty-seven years (range, thirteen to seventy-two years). Over-all, only fourteen (44 percent) of the thirty-two feet benefited markedly from the operative procedure (a good or excellent result). Of the five patients (five feet) who were completely satisfied, three had another lesion (a ganglion cyst, an accessory navicular bone, or a medial talocalcaneal coalition) in or near the tarsal tunnel that had been treated at the same time. Eleven patients (twelve feet ) were clearly dissatisfied with the result and had no long-term relief of the pain (a poor result). The pain was decreased in six feet (19 percent), but the patients still had some pain and disability (a fair result). There were four complications (13 percent): three wound infections and one delay in wound-healing. Twenty-two feet had had preoperative electrodiagnostic studies; the results of eighteen studies were considered abnormal and supportive of a diagnosis of tarsal tunnel syndrome. However, there was no correlation between the clinical outcome at the latest follow-up visit and the results of these studies. Over-all, the patients in the current series had less improvement than those who have been reported on previously."

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