Tarsal tunnel
Tarsal tunnel syndrome is a ductal syndrome characterized by painful compression of the posterior or anterior tibial nerve.
Definition of tarsal tunnel syndrome
Julien Lopez specializes in the management of Tarsal tunnel syndrome.
The posterior tibial nerve runs through the posterior part of the calf, the heel, as well as the sole of the foot. It passes through a fibrous channel called the tarsal channel.
Symptoms include burning and tingling that usually occur during walking or wearing inappropriate footwear.
The diagnosis is based primarily on the clinical examination of the foot with additional examinations.
Depending on the progress of this pathology of the hindfoot, corticosteroids, orthotics or surgery may be necessary.
Like all pathologies, the sooner the syndrome is managed, the greater the chances of nerve recovery. If the nerve is too damaged, the damage can be irreversible.
Symptoms of Anterior Tarsal Tunnel Syndrome
Anterior Tarsal tunnel syndrome is manifested by the appearance of various symptoms:
- Pain in the ankle, foot and sometimes toes.
- Burning or sore tingling during walking or wearing certain footwear.
The pain usually sits at the ankle and radiates towards the toes. It worsens during walking and is relieved at rest.
With late management of the syndrome, the pain can worsen and even occur at rest.
Causes of posterior tarsal tunnel foot syndrome
Foot tunnel syndrome is often secondary to a pre-existing condition or trauma to the foot or ankle.
Posterior tibial nerve compression at the tarsal duct may be due to:
- A flat foot
- A broken foot
- Swelling of the ankle following kidney or heart failure
- Hypothyroidism
- Osteoarthritis
- A local tumor
- Vascular malformation
- Inserted low muscular body or accessory tendon
- Wearing shoes that are too narrow
- Poor foot posture
- Inflammation of the tendons inside the ankle
Tarsal tunnel intervention: the diagnosis
Prior to the tarsal tunnel procedure, a precise diagnosis must be made. The latter is based on a clinical examination of the foot and ankle. Dr Julien Lopez will look for specific palpation pain. The percussion of the nerve compression zone will also cause tingling (Tinel sign) in the heel, arch and toes.
Additional medical imaging studies may be prescribed to confirm the diagnosis:
- X-ray of the feet and ankle for bone deformities.
- An electromyogram to show signs of suffering of the nerve or its branches.
- An MRI may be requested to investigate other causes.
Conservative treatment: infiltration of the Tarsal tunnel, orthotics…
There are several treatments for tarsal duct syndrome. According to your case, Dr. Julien Lopez will propose different alternatives: injections of the Tarsal tunnel, orthotics or surgery.
Non-surgical treatment is first-line treatment.
Treatment of the cause
The management of tarsal duct syndrome begins with the identification of the cause. Once the cause has been identified, a specific treatment can be implemented.
If the syndrome is caused by a pre-existing pathology (rheumatoid arthritis, gout, etc.), this disease should be treated over the long term by means of multidisciplinary treatment.
The patient must also remove any contributing factors. You will have to opt for suitable soles and avoid wearing high heels and narrow shoes.
Corticosteroid injections
The main purpose of corticosteroid injections is to relieve pain by injecting a mixture of corticosteroids and anesthetics into the painful area.
It is also possible to use non-steroidal anti-inflammatory drugs at the beginning of treatment to relieve all symptoms.
Orthotics
The wearing of orthopedic soles allows to correct the collapse of the ankle or foot and thus to limit the constraints on the tarsal channel.
Tarsal tunnel operation
In case of failure of the conservative treatment over a period of more than 6 months, Dr. Julien Lopez will discuss with you the modalities of the operation of the Tarsal tunnel.
The purpose of this surgery is to remove nerve compression. To do this, the surgeon cuts a ligament located in the subcutaneous plane and which is sometimes hypertrophied.
In the case of tarsal tunnel syndrome, surgery is usually performed under local or spinal anaesthesia. To significantly reduce post-operative pain, it may be associated with local anesthesia of the main nerves of the foot.
The surgery takes about 60 minutes.
Recovery and resumption of activities after Tarsal tunnel surgery
Dr Julien Lopez explains the various stages of recovery after surgery of the Tarsal tunnel.
Walking is permitted after the first postoperative day using a cane for a duration of 2 weeks. Once this period has passed, you may bear your full weight.
A check-in consultation is carried out at 3 weeks and 8 weeks after the operation.
«Soft» sports activities such as swimming, cycling and walking can resume from the 4th post-operative week.
It will take several months to resume more intense sports activities.
Possible complications
The rare complications of tarsal tunnel surgery are:
- Healing problems
- Persistence or recurrence of symptoms
- Thromboembolic complications
- Postoperative hematoma
- Algodystrophy
- Phlebitis
