SHORTENED VIDEO VERSION OF THIS ARTICLE


tarsal tunnel syndrome

--> tarsal tunnel



WHAT IS A TARSAL TUNNEL



Tarsal Tunnel Syndrome is the compression of the main nerve (posterior tibial nerve) that passes under the medial or inside part of the ankle. Peripheral nerves such as the nerves in the feet are richly endowed with their own blood supply and have the ability to stretch or shorten along with the movement of the accompanying joint; in this case the ankle joint.

When the nerve is entrapped in its tunnel the swelling that occurs around the nerve and the ensuing scarring of the nerve inhibit blood flow to the nerve. As the ankle joint continues to move the nerve is further compressed and the ability of the nerve to properly function is diminished.

Below is a anatomical diagram of the tarsal tunnel band represented by the white arrow, while the yellow arrow is pointing to the nerve.

anatomy of tarsal tunnel

factors that lead to tarsal tunnel

Causes of this syndrome include trauma such as a fall, acute or chronic pronation of the foot that creates excessive pressure on the inside of the ankle. Additionally, a tendonitis of the tendon that passes through the tunnel can create similar symptoms because as the tendon swells it creates excessive pressure within the confined area putting pressure on the nerve. A such as a ganglion cyst in the canal will also put excessive pressure on the nerve, again creating similar symptoms.

Below is an example of pronation. See how the arch has collapsed. This creates excessive tension on the inside of the ankle thus causing pressure on the nerve.

excessive pronation in stance


symptoms of tarsal tunnel

Symptoms include burning or numbness usually on the bottom of the foot. It may be worse when standing or walking. There may also be muscle weakness of the muscles that run through the bottom of the foot. The distribution of pain or numbness is dependent on which nerve branch of the posterior tibial nerve is most affected. For that reason all of the foot or only certain parts of the foot may be affected.

Diagnosis is made by the history of the pain or numbness in the area of the distribution of the nerves on the bottom of the foot. Tenderness may be noted over the nerve just behind the ankle joint. Tapping with a finger may send sensations both forward into the foot and backward up the leg; this is known as a positive Tinel's sign. Your foot specialist should be able to determine the distribution of numbness with simple tests. There may also be muscle weakness particularly in the inability to bend your toes in a downward fashion.

Your foot specialist may also order an electromyogram (EMG) which may reveal decreased nerve conduction across the tarsal tunnel. If your doctor feels there may be a soft tissue mass, he may order an MRI.

The Kinoshita test is a pronatory "stress test". Your doctor may attempt to bend your foot upwards and at the same time pronate the foot. The foot is held in that position for ten seconds. At this point, if you have tarsal tunnel syndrome, you will start to feel the symptoms. This test was developed in 2002 and in the initial study after the patients went on to have surgery, the effectiveness of the test was confirmed in 42 out of 43 feet.

Other foot conditions may mimic the symptoms of this condition. These may include radiculopathy (nerve impingement in lower back), diabetic neuropathy, peripheral neuropathy, rheumatoid arthritis, vascular disease, Baxter's nerve (heel neuroma), plantar fasciitis, scar tissue from previous trauma or surgery, ankle edema (swelling) and possibly a growth like a ganglion cyst, or lipoma (fat tumor) in the canal.

TREATMENT OF TARSAL TUNNEL



Treatments include the use of orthotics when the origin of the problem appears to be excessive pronation.

An orthotic will prevent the foot from over pronating and thus relieve the pressure on the nerve. Click here for a discussion of tarsal tunnel and orthotics.

If the origin of the problem is traumatic in nature, a short leg walking cast may be indicated as the cast will prevent the ankle from moving at all and will allow the inflammation in the tarsal tunnel to subside.

Adding a heel lift to the walking cast can be helpful as the slight plantarflexion that is created also helps reduce the tension and pressure on the affected nerves.

Along with the above treatments your foot specialist may also prescribe oral anti-inflammatory medicine to help reduce the inflammation.

Oral or injectable steroids may also be of benefit.

Transcutaneous nerve stimulation may be helpful as a supplemental treatment as long as the underlying cause of the tarsal tunnel is being addressed.

If none of the conservative avenues work then you must consider surgical intervention. Aside from the existing symptoms, if the pressure is not removed from the nerve, the nerve will eventually fail all together making it almost impossible to walk. The surgery itself is a soft tissue procedure whereby the ligament band pressing on the nerve is incised; the posterior tibial nerve is freed from all constricting bands. This is an out-patient procedure. You will usually require a walking cast. However, prior to consenting to surgery other causes of these symptoms should be ruled out. These include diabetic neuropathy, a pinched nerve in the lower spine, alcoholism, rheumatoid arthritis and heavy metal neuritis just to name a few.

TARSAL TUNNEL RELEASE


This is a soft tissue procedure that can be performed on an out patient basis. An incision is made just underneath the inside of the ankle bone. The laciniate ligament is a ligament that binds or holds all the vessels and nerves as they pass under the ankle joint. This ligament is incised in an effort to release the pressure that is pressing on the posterior tibial nerve which is causing the tarsal tunnel symptoms.

In addition to releasing the ligament, the area is inspected for the possibility of a growth such as a ganglion cyst which may also be causing pressure on the posterior tibial nerve. Any adhesions (fibrotic tissue attached to the nerve) is also dissected away thus freeing up the nerve.

The skin is closed. The patient may or may not be placed in a walking cast based on the preference of the surgeon.


curvilinear incision for tarsal tunnel

entrapped nerve under laciniate ligament

release of laciniate ligament







Want more information? CLICK HERE



Specific Recommendations For This Condition



KLM ORTHOTICS
In my opinion, the best pre-made orthotic available. Offers the best combination of support and cushioning. Will work in the greatest percentage of people who try a pre-made orthotic. (keep in mind, everyone's foot structure is different and so unlike a prescription orthotic, pre-made devices can be hit or miss). In order to treat capsulitis, this orthotic has to be ordered with a metatarsal pad. Click the link below for a full description.

superstep_orthotics



REDITHOTICS
Many of you are forced to wear dress shoes on a daily basis and it can be difficult to get an orthotic into a dress shoe since there is limited space. Redithotics are a pre-made orthotic designed specifically for this purpose. In order to treat capsulitis, this orthotic has to be ordered with a metatarsal pad. Click the link below for a full description.

redithotics





download from Apple Store
Get it on Google Play

ORTHOTICS for multiple types of foot pain
best buy in a pre-made orthotic
click link below


SuperStepOrthotics


ORTHOTICS for heel and arch pain for those who must wear dress shoes
click link below


redithotics


Topical pain reliever
click link below


blu-mjk


Relief for nail fungus
click link below


clotrimazoil





I've been doing some aggressive research lately (it's how I found your incredible website) and realize now that my symptoms are not consistant with the diagnosis.

Jennifer

Hunterville, NC


….after reviewing your amazing site (great for the avg. jill). So thank you very much!!!

Liesbeth

NY
I am really, really impressed with your plain-speak explanations for the various conditions.

Jacqueline

NJ
This was an extremely helpful site. I have an appointment on the 18th and your info. Was right on target…..

Jack

Fla
A well organized site containing much information written in a manner that the average reader can comprehend.

Jean

Ontario, Canada
I found your website and articles most interesting.

Andrew

Fla.
Thank you for a quick response. I think your site is the best information site on foot pain and I have viewed many.

Judy

(location unknown)
I came to your website, footspecialist.net via www.foot-pain explained .com which I think is also your website? I thought explanations for different types of problems were well addressed and thoughtfully stated for the patient in mind.

L.W.

New York
You have an amazing and extremely informative site. I enjoyed looking through all of the data and stats.

Yvette

Memphis, TN
Thanks again so much for the information in the article. Very interesting.

Anna

Scotland
Great article. I have had plantar fasciitis since I was in high school……..

J. Simmons

(location unknown)
Dear Dr. Mitnick, The orthotics arrived four days ago and I slipped them into my shoes immediately. I was skeptical as to the usefulness of the item, they really didn't look very exotic. I have to say though, after using them for just four days, I have experienced grand relief from my foot pain. Even the very first day, I was able to do a lot of work while on my feet with at least a 75% reduction of pain. It has only gotten better every day, and I go nowhere without my shoes with the orthotics. I had been experiencing extreme heel and sole pain for about six months and had to take extended breaks off my feet many times a day as well as regular doses of Ibuprofen. Since getting the orthotics, my life has returned to normal and I feel good again. Just wanted to say thanks for the recommendation for a very effective item, I had no idea what a change this item could affect.

Yours truly,

J.C. Forbes

Tennessee
Thanks for the Response, you hit it on the head.

Steve

Redondo Beach, CA
Thank you for your time and expertise in answering my question…..

LH

(location unknown)
First, thanks for putting together this website. Its the most informative site I have found dealing with foot problems. Last June I started having pain and swelling at …….

Joe

(location unknown)
First of all, thank you for having all this useful information available in one place. I've been through most of your website and based on my research, pain and evaluations I think I've narrowed things down quite a bit.

Pete M.

(location unknown)
Thank you for the best site I have found when researching foot pain.

Glenda B.

Madison, Alabama
Thanks for replying so quickly. I was a bit concerned. I think your website is great, and chock full of info.....

Carol

Denison, TX
Dr. Marc, Thank you so much for your reply which seemed to be right on. I have researched many sites but you put me on the right path to the possible answer. My foot pain may not rule the rest of my life after all! I believe I'll make a sign that reads, "THE END IS NEAR!" Thanks Very Much,

Dawn

West lafayette, IN
Dear sir...no doubt you get positive comments re your site...May I please be added to the list of your admirers. In all of my years of web surfing I would say your site is right there with the very best. Thank you for taking the time to write the terrific info you provide and for putting things into laymen terms for us mere mortals. I pray you have much on going success and thank you again for a deed well done. As for me I did not find much help for my symptoms and will continue on my quest. Were you anywhere in the South I would make and appointment...Thanks again dear sir...m.e.

Michael E.

Tampa, Florida 33624
Hi. This is a great site! I'm a healthy middle aged woman who is in good health, but.....

Kelly

Texas
Just a wee word of thanks for your wonderful website...It is a terrific service...Thank you for providing your knowledge and help...With highest regards, m ebeling

Michael D. Ebeling

Tampa, Florida 33624


Thanks for a most interesting website, which has helped a lot.

Steve

UK


Dear Dr.Mitnick

I usually do my research on the Mayo clinic website. I think your website is the most informative site I have found when researching foot pain.

I thank you for putting together this incredible website.

Regards,

Dragica W.

Edmonton,Canada


....I have been told that it is not hard enough to be cut off. Please help, I am not sure what to do now! THANKS FOR A WONDERFUL AND VERY HELPFUL SITE!

Roxy

South Africa


You have an unusually clear, informative and well-written website for laypersons. Thank you for that.

Matthew W.

Mansfield Ctr, CT


First, I'd like to thank you for all the information that you provide on your website and the opportunity to write to you.

Steve

Placentia, California


First, I want to let you know that you have the best web site I've found related to foot issues. (The only thing I had difficulty finding was the "ask a question" page.)

Unknown

Unknown location


I received the orthotics Monday afternoon and began wearing them Tuesday. After two days I would say that I have noticed a huge improvement in the discomfort I have been experiencing. My foot feels better than it has in months.

Ric J.

Unknown location


I greatly admire someone like you who would donate and dedicate so much time and effort to helping strangers with no compensation. Truly, it is uncommonly kind. And your site is so intelligently arranged.

Ron R.

Pacific Grove, CA


I used to work for a podiatrist (front desk) back during summers in college years ago, so I know the benefits of good care. Again, I want to thank you for an EXCELLENT website. It was so great to get to your site (top of google search) and actually find all the answers I needed EASILY and QUICKLY! Clearly you put a ton of work into it and I really appreciate it.

All the best,

Victoria

Alameda, California


By the way, millions of websites could use yours as a guideline on how to organize information and make the site user-friendly. Kudos to you!

Anonymous


Thank you for your very interesting and informative site!

Anonymous




Hi. I come to your site often looking for information. It is really informative and I appreciate it very much. I have RA and have been having considerable amount of foot pain...... Dee RN


Thanks very much for the wonderful informative site.

Catherine

New Zealand


Thank You for my answer! I have been schedule for a bone density scan, allingment, and I am in the process of getting orthotics made, and checking out the natural remedies. Thank again! What a great web site!

Sincerely

Josette


Yes I want both pair of orthotics. You don't have an option of ordering 2 at one time so I had to place the order twice. Thanks. My husband likes these and wants to put them in all of his shoes. (referring to Superstep orthotics)

Cindy H.

Arizona
I searched the internet everywhere for a clear description and illustration of my symptoms/problem. http://www.foot-pain-explained.com/ was where I ended my search with answers. If I lived in Jersey (left 30 years ago) and didn't live in Florida I would definetly make an appointment with Dr. Mitnick.

Thanks, Kathy

Florida
1st of all THANKS A LOT for your great site......

Anna

Poland
Thank you so much for your response. I will let you know how I am doing if you would like. Your website is awesome!

M P

South Carolina
Hello! I want to thank you for such an informative website! I found you based on my ankle pain search and am happy to realize that there may be a relatively simple cause and solution....

Natalie

unknown location


...Thanks for your fantastic service.

Gary

Arlington, VA


Thank you so very much, that would be much appreciated. I love those insoles, by the way. (referring to Superstep orthotics)

Kelly W.

San Clemente, CA


Dr Marc is fantastic...He seems to know exactly what you are feeling with the problems you are having. I wish he was in my home town so I could go to him with my problems!!!!!!!!!!!!!

Pam

location unknown


Great insights! Thanks Doc, you're the best.

Glen

location unknown


I have been experiencing foot pain of various sorts and am working to figure out what it is. I found this site and can only say BRAVO!! What an excellent site! The time it must have taken to put all this together must've been a daunting task! I am sure it has helped so many people. Thank you so very much for doing this.

Bre

location unknown


Dr. Mitnick, Thank you so much for your reply. I did let my physician know and they took an x-ray - all is well! Also, thank you for providing this wonderful site, it is very helpful with lots of useful information! I appreciate your gift of time! God bless.

anonymous




Dr. Mitnick, Thank you, you were 100% correct. The pain finally brought me to the ER. I spent 8 days in the hospital. The Doppler you spoke of was able to show that there was no pulse in that foot. This was an arterial clot that split and traveled throughout my leg. My leg was almost amputated. I am in rough shape but have all my parts intact!! You certainly know what you are talking about. Thank you for taking the time to answer. Yours Truly!

anonymous




Staying at home after hallux surgery I spend quite a lot of time seaching info useful for avoiding problems which might come back. Today I found your site and I am .... delighted it happened. It's one of the best site I found last days.

Anna

Poland




Thanks for taking time to read and answer so many questions. It is truly a public service!

Esh

Seattle, WA


I just wanted to say that I am very greatful for this website!!

Bonnie

location unknown




Also, and importantly, just want to praise this web site. Thorough and thoughtfully presented, it certainly must be of considerable assistance to anyone with a foot problem. Terrific -- and very interesting.I trust the address comes up easily for those seeking information.

Bill

New Jersey




Thanks so much for answering my question. You've been more help to me than my own Dr. has been lately. Thanks again....I hope to be able to walk without pain someday.

Debbie

location unknown




Wow, that is exactly the information needed!!! thank you thank you thank you!!! I appreciate this help so very much from Marc Mitnick DPM. Excellent information and help to improve One's life.

Chrissy

location unknown




Thanks so much for this website Dr. Marc! It is so nice that you have this ask the doctor feature..I'm sure I'ts been helpful for alot of people. I will try what you suggested and see if it helps...thanks again!

Tracy

Evansville, IA




Dear Marc

I just want to say thank you for the quick response and the good info. I find it amazing and a super nice thing that you do here by answering medical questions at no charge.

Russ W.

location unknown




Your website is full of a lot of helpful information, and I am very impressed with the time in which you responded to my post. Thank you again for your time and consideration in your response.

-Sunny.

location unknown




Thank you very much for the information, I will consider it. Excellent web site.

Jackie

San Diego, CA




Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

Rivi,

Albany, NY




Thank you so much for all of your advice. In searching the web for people dealing with this same issue i can tell you that you are a Knight In shining Armor! If I lived in Jersey I would gladly be your Spokesperson. Hopefully next time you hear from me it will be good news. God Bless,

Jill S.

location unknown




THANK YOU SO VERY MUCH FOR YOUR TIME AND EFFORTS, YOU ARE SO VERY APPRECIATED. THANK YOU FOR ALL YOU DO.

Jackie

Whichita, KS




thanks again, this site is very helpful.

mark

Boston, MA




Like others have stated...This site is amazing and I am so thankful that it was created.

....Keep up what your doing. Your a life saver.

Michelle

Colorado




Thanks again for the information provided on your site. It's easy for non-medical folk to understand your writing, and helps provide better communication between patient and doctor.

annielou

Colorado


Wonderful advice

by: Anonymous

This is the best site for foot problem info.


Thank you for this information. This description fits my pain and inflammation behind my 2nd toe perfectly.

by: Max

location unknown
Again, I really appreciate that you responded to my inquiry, and that your mention of Parkinson's helped me to find my way to a diagnosis of this difficult to diagnose disease. Most patients see on average 16 doctors before they are diagnosed. I hope that you can help other people that ask for your expertise in the future.

Barb D.

Canada
I just wanted to say that I am very greatful for this website!! I have had a fusion in my rt foot and am finally getting a little bit better......

Bonnie

location unknown
Again, Thank you from the bottom of my heart for taking the time to answer my question....your an angel!

Nancie

Wisconsin
Thank you for your response. You have provided some great insight (to my question)....

Julie

location unknown
Thank-you so very much for responding so quickly and in such detail to my question!! I will give my surgeon a call today!! This website is terrific!!!! Thank-you again!

Renae

North Carolina
Many Thanks Dr Marc!
Thank you for your response. It sounds like a good plan to me. He did not cut the wart out first ...

KG

location unknown


Thanks again doc for having this website and we STILL need qualified Podiatrists in beautiful sunny Tampa Bay (Bradenton) Florida.

Bessie Mae

Florida
Dear Dr. Mitnick, Thank you so very much for taking your time to answer my question. You have greatly relieved my anxiety related to the continual tingly I feel in my feet. I will share your response with my podiatrist next week. God bless you for having this question and answer page on your website! Most gratefully,

Lynne T.

location unknown
Your webpage is excellent, I commend you on sharing your knowledge to the public.

Robert

New Jersey


Thank you. you were more detailed than what others have told me they finally called from the last xrays and my son is now in a cast for 2 weeks he did have a fracture that was not noticeable.

a mom

location unknown


I have read your website and I have to admit that I am amazed at all the information that is on here. I have learned more than the three years I have been going to several doctors that I have seen!!

Melody

Lenoir, NC


Thank you so much Doc for a quick and thorough response!

Rustam

Bellevue, WA


I cannot thank you enough for your response, opinion, and suggestions! I want you to know how much it means to me, and I'm sure everyone else who has ever asked you a question! I feel like you're a lifesaver and have empowered me to take a stronger role and stand up for myself and my feet!

Jodi

location unknown