The tarsal tunnel is where the main nerve passes as it goes into the bottom of the foot and into the toes. Varicose veins, overpronation, ankle injuries, arthritis, and diabetes are some conditions associated with tarsal tunnel syndrome. Flat feet and low-heeled shoes aggravate the signs and symptoms. It is very common but often missed in diagnosing heel pain or plantar fasciitis.
Symptoms
- tingling, burning, electrical sensation, and numbness in the heel and arch, sometimes the toes
- Prolonged standing and walking make symptoms worse
- often a slight swelling locally over the inside of the ankle
- diabetes causes the nerves to swell causing an entrapment of the nerve in the tarsal tunnel
Diagnosis
- Examination initially suspects the diagnosis: tapping on the nerve may produce a Tinnel’s sign, causing radiating pain into the arch and sometimes to the toes.
- Nerve testing is used to specifically test for tarsal tunnel syndrome. It is important to differentiate between low back pain, neuropathy, and other problems
- An MRI is ordered if a mass, varicosities, or ganglion cyst is suspected. An MRI of the lower spine may also be ordered.
- A drop of local anesthetic may be delivered to the tibial nerve to help differentiate tarsal tunnel from heel spur pain or plantar fasciitis.
Treatment
- Rest, elevation, anti-inflammatory medications
- Ankle splints and elastic ankle supports to rest the nerve
- Orthotics are important and very effective in controlling injury to the nerve during walking. Overpronation and flat feet are especially prone to this.
- Injection therapy
- Surgery to decompress the nerves. This involves uncovering the nerve by opening or releasing the constricting tissues causing the tarsal tunnel syndrome. Dr. Young has special training in this procedure.
It is important to learn the cause of injury to the nerve to determine the treatment plan.
