Tarsal Tunnel Syndrome

Do your feet burn or tingle? Do your feet feel like they have fallen asleep?

If you answer yes to either or both of these questions, you may have a condition known as tarsal tunnel syndrome. This syndrome can occur in one foot or both feet and is similar to the common carpel tunnel syndrome in the hand. Patients often complain of tingling or burning in the foot or feet with electrical-like sensations shooting out to the toes or up the leg. In many cases, the condition is aggravated by prolonged standing or walking and wearing shoes that are not supportive. Varicose veins and swelling in the ankles can also exacerbate the problem.

To understand the cause of tarsal tunnel syndrome, one must first have an understanding of some basic anatomy. The tibial nerve is the large nerve that supplies the muscles and the skin on the bottom of the foot. The nerve runs down the inner portion of the lower leg, behind the inside of the ankle and dives deep into the muscles on the plantar surface (bottom) of the foot. At the area behind the ankle, the nerve lies under a broad ligament that can impinge the nerve. The nerve then undergoes an inflammatory process and can enlarge, further impinging the nerve in the small area it occupies under the ligament. Eventually, the nerve fails to transmit impulses to the muscles and relay sensory information properly. This may result in pain, numbness and tingling or burning sensations.

Prompt diagnosis and treatment is helpful in alleviating symptoms. The podiatrist should perform a complete examination of the feet and obtain X-rays and possibly other diagnostic tests to ensure that symptoms are not caused by other illnesses or inflammatory conditions. Once the diagnosis is confirmed, treatment should be initiated and may consist of serial steroid injections, anti-inflammatory medications, orthotics (custom made shoe inserts) and physical rehabilitation modalities.

In some cases the inflammation around the nerve does not decrease with conservative treatment and a minor surgical procedure must be performed. The procedure is performed on an outpatient basis allowing the patient to return home the same day. After a brief period of recovery, the patient may return to activities.

The pain created from tarsal tunnel syndrome can be quite disabling and may interfere with occupational performance or recreational activities. The prognosis for successful treatment is directly related to how early the problem is recognized and treatment is initiated.