Tarsal Tunnel Syndrome

Tarsal Tunnel Is Frequently Misdiagnosed

The Tarsal Nerve

Can vary between individuals and so entrapment or compression of tibial nerve may produce different symptoms. This can make it more challenging to clinically differentiate Tarsal Tunnel Syndrome from other foot conditions like plantar fasciitis and Morton’s neuroma

Tarsal Tunnel Syndrome can result in foot pain, tingling sensation, swelling of the affected foot, burning sensation, numbness in toes, needle like sensation. There may be a worsening of pain and discomfort after heavy labor and the pain can even radiate to the leg, heel and abdomen. Sometimes, there is temperature sensitivity (in which the patient feels hot and cold sensations in feet.)

Tarsal tunnel syndrome is often confused with Plantar Fasciitis or Morton’s neuroma. Tarsal Tunnel Syndrome is characterized by the entrapment of tibial nerve during its passage from the tarsal tunnel affecting both sensory and motor functions of the lower limb. It can mimic Plantar Fasciitis or Morton’s neuroma in clinical presentation.

Any condition that aggravates the pressure on the tibial nerve or compress the contents of tarsal tunnel can lead to tarsal tunnel syndrome (such as flat arches). The specific factors that aggravate the risk of tarsal tunnel syndrome are history of moderate to severe trauma on the foot, unstable ankle or foot due to congenital or acquired deformities, ganglionic cysts, varicose veins and bony spur formation.

Diagnosis and Treatment

Tarsal tunnel syndrome can be diagnosed by conducting a detailed history and extensive clinical examination. A positive Tinel’s sign for tarsal tunnel syndrome is characterized by onset of pins and needles sensation along the inner aspect of the foot when the examiner taps behind the inner prominence of the ankle (the medial malleolus).

An EMG (electromyography) study can also help make the diagnosis. An EMG test is a procedure that measures the electrical conductivity of the nerves. A decline in electrical conductivity suggests an entrapped nerve. However, keep in mind that an electromyography (EMG) study is not always reliable, as decreased conductivity is also observed in arthritis.

Most clinicians adopt non-surgical options to address the symptoms of pain and discomfort.

Surgical management options include releasing the lacinate ligament and decompression of the posterior tibial nerve by surgical manipulation. Generally, the recovery time varies from 4 to 18 months and the outcome depends on the degree of entrapment.

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