Tarsal Tunnel Syndrome

Written by Michelle Champlin BSc Pod., M.Ch.S., S.R., Ch., (UK)
What is ‘Tarsal Tunnel Syndrome’?
The ‘tarsal tunnel’ is the canal between one of your ankle joint bones and a special band of ligaments that stretch across your foot. The ankle bone involved is called the medial malleolus – that’s the bone that sticks out on the inside of your ankle. The band of ligaments is called the ‘flexor retinaculum’ – also known as the internal annular ligament. It’s a strong band of fibres that extends from the malleolus at the tibia bone to the calcaneus (heel bone). It encloses the tendons of the muscles that help your foot to flex, as well as blood vessels and nerves for your tibia. This important tunnel holds the nerves, blood supply and tendons that control the foot’s movement and flexibility.
Tarsal tunnel syndrome is the ankle equivalent of ‘carpal tunnel syndrome’ which is caused by compressed nerves in the wrist joint.
Symptoms
The main nerve contained in the tunnel is the tibia nerve. This nerve’s job is to provide the feeling, or sensation, for the sole of your foot. When this nerve gets compressed, this can lead to:
• Tingling
• Numbness
• Burning sensation or pain
usually along the sole of the foot or inside of the ankle. Symptoms may come and go, getting worse after long periods of standing or walking. Symptoms can go beyond just the one ankle area, to reach the toes, heel or even calf area.
Causes
Tarsal tunnel syndrome results from a compressed tibia nerve, so anything that compresses or squeezes this nerve can cause it:
• Flat feet – whether over-pronation or pes planus. The biomechanical malalignment from a fallen long arch in your foot causes your heel bone to tilt out, in turn putting pressure on the tarsal tunnel.
• Pressure on the area from a varicose vein, cyst, ganglion, swollen tendon or osteoarthritic bone spur.
• Injury such as an ankle sprain causing swelling and pressure on the nerve
• Diabetes or arthritis – related swelling at your ankle joints / lower limbs
Diagnosis & Treatment
See your Podiatrist if you experience any of the symptoms above. (S)he will carry out a number of tests as part of a complex lower limb assessment to test your nerve function and any sensation problems. (S)he will be able to differentiate between any other ailments and distinguish the underlying cause.
Treatment will depend on the underlying cause of the compressed nerve. Usually, non-surgical treatment will resolve it, including:
• Rest – limit your activity until the Podiatrist gives you the all clear
• Ice – protect the skin with a damp towel and ice for 20 minutes, allowing 40 minute breaks between icing
• NSAID painkillers
• Custom orthotics have proven especially effective where an underlying biomechanical issue is the cause. By correcting the over-pronation, or lifting the collapsed arch for example, the heel bone will be aligned correctly with the rest of the bones of the foot and ankle to maintain correct posture. This alleviates pressure on the tibia nerve.
• Sometimes, surgery may be recommended and your Podiatrist can refer you to the correct specialist orthopaedic surgeons who specialise in feet and ankle surgery, whether here in the UAE or abroad.
Chief Podiatrist Michelle Champlin of Dubai Podiatry Centre says, “I’ve seen quite a few cases of tarsal tunnel syndrome linked with biomechanical causes here in Dubai, possibly due to the number of patients with collapsed arches that we treat. The symptoms of tarsal tunnel syndrome can be very worrying for patients, and we work pro-actively with the patient to resolve these as soon as possible.”
If you are worried about any new or different sensation in your feet contact the UK trained Podiatrists at Dubai Podiatry Centre on +971 4 3435390. If you are diabetic, remember to see your Podiatrist at least every year for your annual foot sensation tests too as part of your diabetic assessment