What is tarsal tunnel syndrome?
Tarsal tunnel syndrome (or tarsal tunnel) is caused by compression or damage to the nerve supplying the heel and sole of the foot (posterior tibial nerve). It results in pain in the ankle, foot and sometimes in the toes.
The posterior tibial nerve is located at the back of the ankle and passes through a fibrous duct (tarsal duct) behind the medial malleolus. The posterior tibial nerve is inserted on the calcaneus, bone of the foot and connects the triceps sural, muscle of the posterior superficial compartment of the leg or calf. Inflammation of the tissues near the tarsal duct compresses the nerve causing pain.
What are the causes of tarsal tunnel syndrome?
Tarsal tunnel syndrome is most often due to extrinsic factors:
- Sprains and misalignment of the ankle and hindfoot;
- Foot fracture and flat foot;
- Fibrous thickening of the partitions;
- Muscle abnormality (hypertrophy of the adductor hallucis);
- Wearing tight shoes;
- Swelling of the ankle as a result of heart or kidney failure;
- Diabetes, osteoarthritis and rheumatoid arthritis;
- Excessive ankle pronation.
But in 25% of cases, there is no cause.
What are the symptoms of tarsal tunnel syndrome?
Pain in the inner side of the ankle is the most common symptom of tarsal duct syndrome. This is accompanied by other symptoms:
- A burning, tingling or tingling sensation in the sole of the foot, occurring when standing or walking, spreading to the knees and to the toes.
- Numbness of the foot with a feeling of paralysis of the toes;
- Pain relieved at rest;
- Calf and foot cramps;
- Night pains with awakenings.
- Paresis of the abductor of the big toe which then straddles the second toe.
- Paresis of the abductor of the 5th toe.
Tarsal tunnel syndrome as a diagnosis
Since tarsal duct syndrome can be seen as other pathologies of the foot, a medical examination by a podiatrist is necessary to identify this syndrome.
To make the diagnosis, the podiatrist uses various examinations:
- Ultrasound and MRI can identify the extent of tissue damage or an expanding process (benign tumor, lymphadenopathy, spider veins) or flexor tenosynovitis.
- X-rays of the two feet and both ankles in frontal and lateral load make it possible to assess the surrounding skeletal state, or the existence of a static or architectural defect that could aggravate the syndrome.
- The electromyogram has good sensitivity. Its role is to confirm the presence of electrical signs of distress in the posterior tibial nerve or one of its branches.
- Clinical and visual examination of the foot to verify its functioning.
- Studying nerve conduction to see if the nerve is affected.
What are the treatments for tarsal tunnel syndrome?
Medical treatments depend on the cause but in general, conservative treatment (rest, icing, shoes) is generally recommended.
NSAIDs (nonsteroidal anti-inflammatory drugs) and corticoid infiltrations can be prescribed as well as ankle rehabilitation sessions
Orthotics, orthopedic insoles.
Surgical treatment is required if conservative treatment fails after a minimum of 6 months. It is based on neurolysis of the plantar nerve, which is a section of the plantar nerve, which frees the nerve from its ligament compression. The operation is performed under general or locoregional anesthesia.
Hospitalization can be outpatient or for a few days depending on the case: The ankle can be immobilized by a splint for 15 days during which support is authorized.
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