Tarsal tunnel syndrome – also called nerve compression syndrome or constriction syndrome – refers to damage to the tibial nerve. This runs through the foot and causes painful symptoms due to damage or irritation.
What is tarsal tunnel syndrome?
The medical profession refers to tarsal tunnel syndrome as damage to the tibial nerve. The localization is mainly in the ankle joint. In that area, the tibial nerve runs through the tarsal tunnel. The tunnel is formed by a taut ligament that runs through the inner ankle of the foot. The tibial nerve is responsible for controlling the muscles of the sole of the foot, and the muscles of the lower leg (which serve, for example, to bend the leg) also depend on the tibial nerve. Subsequently, all perceptions that are present in the lower leg area are also transmitted via the central nervous system. If permanent pressure is exerted on the nerve in the tarsal tunnel, tarsal tunnel syndrome develops. Predominantly, the lower leg as well as the foot are affected.
Causes
In about 80 percent of all cases, a cause is found that is responsible for tarsal tunnel syndrome. Primarily, it is benign bone outgrowths (which subsequently constrict the so-called tarsal tunnel) or also injuries. In a few cases, tumors are responsible; inflammations can also trigger the syndrome in the region of the tarsal tunnel. The tarsal tunnel syndrome is favored by foot-straining sports, a bent flat foot or also injuries of the ankle joint and an arthrosis. Diabetes mellitus or also varicose veins are among the favoring factors. Narrow, too high or rigid shoes, such as ski or Bergbeziehunsgweise hiking boots, can sometimes also be a trigger or significantly exacerbate the syndrome.
Symptoms, complaints and signs
The tarsal tunnel syndrome makes itself felt predominantly by discomfort, which occurs during the night hours. In this case, affected persons complain of a feeling of numbness, a constant tingling sensation, or even a burning sensation, mainly in the foot region. Sometimes those symptoms can also radiate (calves); the area of the inner ankle is permanently sensitive to pain. Symptoms may be aggravated by prolonged standing or walking. However, if the foot is elevated, the pain disappears. The symptoms occur at irregular intervals at the beginning. Only as the disease progresses do the persistent phases increase; the nerve continues to be damaged, so that the pain is permanent. The affected person subsequently feels significant muscle weakness, so that foot movement can no longer be performed properly.
Diagnosis and course of the disease
If tarsal tunnel syndrome is suspected, a medical professional must be consulted immediately. Only with timely treatment is it possible that further nerve damage can be prevented. The attending physician, ideally an orthopedist, will ask the patient various questions that form part of the medical history. For example, how long the patient has been suffering from the symptoms and when they became particularly intense. The physician then examines the foot. Only by “tapping” the inner ankle is it possible that the affected person has already reported pain. If muscle weakness is present, this may already be the first sign of local inflammation. Swelling as well as warmth are also sometimes indications that it could be tarsal tunnel syndrome. The physician checks the musculature by means of ENG – electroneurography. Through that examination, the speed and impulse of the nerve are checked. The diagnosis of tarsal tunnel syndrome can be confirmed by an X-ray. In many cases, an MRI – magnetic resonance imaging – can also provide the information about whether it is the so-called syndrome. If the tarsal tunnel syndrome is treated too late or not at all, the symptoms intensify. The nerve suffers irreversible damage. For this reason, it is important that treatment – as early as only possible – takes place. If permanent damage has already occurred, predominantly affecting the tibial nerve, even surgery may not provide relief.
Complications
First and foremost, those affected by tarsal tunnel syndrome suffer from various sensory and sensory disturbances.These have a very negative effect on the quality of life and can lead to restrictions in movement and generally in everyday life. A feeling of numbness can also develop, and those affected often suffer from a tingling or burning sensation in the respective region. The pain can also radiate into the calves. The symptoms often occur not only when walking, but also when standing or sitting. At night, the symptoms of tarsal tunnel syndrome can lead to insomnia and thus to irritability of the affected person. If left untreated, tarsal tunnel syndrome leads to muscle weakness, whereby ordinary movements of the foot can no longer be performed easily. If the nerve becomes irreversibly damaged, no further treatment is usually possible. The treatment itself is done with the help of cortisone and can limit the symptoms. In the case of a tumor, it must be surgically removed. Patients are usually dependent on therapies even after successful treatment.
When should you see a doctor?
If irregularities occur in the tibia or lower leg, the processes should be further observed. If there is a one-time overload of the organism, relief of the discomfort will occur already after a period of rest or sparing. If permanent freedom from symptoms is achieved after a restful night’s sleep, there is no need for a medical check-up in most cases. In the future, physical activities should be oriented to the needs of the organism. If complaints or irregularities persist over a longer period of time or increase in scope and intensity, a doctor should be consulted. A tingling sensation on the skin or a burning sensation indicate a health disorder that needs further investigation and treatment. Pain, hypersensitivity to touch stimuli, or a decrease in physical performance should be investigated and treated. If the affected person complains of irregularities of the inner ankle as well as the foot, this is considered a sign of a present disease. Disturbances in general movement as well as a general feeling of illness should be discussed with a physician. If pain increases during locomotion, clarification of the cause is necessary. If everyday obligations or usual sporting activities can no longer be performed due to the impairments, a medical examination should be initiated.
Treatment and therapy
The medical professional must take care to reduce the so-called mechanical pressure that lies on the nerve. By means of shoe insoles, it is possible that the load that the foot must bear is “transferred” to the outside, so that the inner foot perceives a relief. Medications are used to combat and alleviate the symptoms, but do not represent a treatment of the cause. Inflammatory processes are treated primarily by cortisone; the surrounding tissue, which is swollen, can be decongested by the administration of cortisone. The decongestion can relieve pressure on the nerve. Conservative treatment is used for about two months. If there is no significant improvement after that, the physician must inform the affected person that tarsal tunnel syndrome can also be treated surgically. During the operation, the tight ligament surrounding the tarsal tunnel is removed. In a few cases, parts of the nerve sheath must also be split. Tumors or bone outgrowths must also be surgically removed. After the operation, it is important that the patient relieves the pressure on the foot – by means of crutches. The success of the operation also depends on what concomitant diseases were present that led to the tarsal tunnel syndrome. Rehabilitation lasts six months; in some cases, further surgery is necessary.
Prevention
Tarsal tunnel syndrome – if it is caused by injuries or even tumors or bone outgrowths – cannot be prevented. Important are good footwear (no permanent wearing of high or stiff shoes) as well as the treatment of diseases, which can promote the tarsal tunnel syndrome.
Aftercare
If tendinosis calcarea must be treated surgically, subsequent follow-up care is exceedingly important. After the surgical procedure, the affected shoulder should be rested for approximately three weeks.To treat the pain, the patient receives medication that has an analgesic and anti-inflammatory effect. An important part of the aftercare of a calcified shoulder is the subsequent physiotherapeutic exercises. They take place after the acute pain has subsided. After the tendon has healed, pain-adapted mobilization treatment is performed. If passive exercises are performed in the first phase of therapy, active exercises are performed in the second phase, which are useful for achieving full range of motion of the shoulder joint. Pain-adapted therapy is understood to mean exercises that only put as much strain on the shoulder as the pain allows. The pain threshold must not be exceeded. Postoperative follow-up treatment also includes a third phase. In this phase, the stability, strength and muscle coordination of the affected shoulder can be completely restored. Normally, the pain after calcified shoulder surgery has noticeably subsided after 24 to 48 hours. Therefore, further follow-up treatment, which is performed on an outpatient basis, can usually be carried out without difficulty. The patient’s general state of health and any previous illnesses are also important. In about 90 percent of patients, long-term satisfaction can be achieved through follow-up care.
Here’s what you can do yourself
Patients with tarsal tunnel syndrome suffer from sometimes severe pain in the area of the affected foot. The associated restrictions in the mobility of those affected often lead to a temporary decrease in quality of life as well. In order to reduce these complaints conservatively and through self-help measures, patients with tarsal tunnel syndrome first discuss the available options with their orthopedist. Usually, those affected are given special insoles for their shoes to provide relief. Patients treat the severe pain with medications prescribed or recommended by their doctor. To support the healing process, those suffering from tarsal tunnel syndrome temporarily refrain from sports activities. They also reduce, if possible, the physical stress to which they may be exposed at work. If conservative measures do not bring about any improvement, surgery is usually the remedy of choice. Special physical rest is required before and after this operation. After the operation, patients take a few days off work and use walking aids to relieve the pressure on the operated foot. Together with their orthopedist, patients discuss measures for effective prevention of recurrence of tarsal tunnel syndrome. Among other things, this includes adjusting usual sports activities.