ANATOMI

TARSAL TUNNEL
SYNDROME(TTS),
also known as posterior tibial neuralgia,
is a painful foot condition in which the tibial nerve is impinged
and compressed as it travels through the tarsal tunnel.
TTS is a compression syndrome of the tibial nerve within the tarsal
tunnel.
This tunnel is found along the inner leg behind the medial
malleolus (bump on the inside of the ankle).
The posterior tibial artery, tibial nerve, and tendons of the tibialis
posterior, flexor digitorum longus, and flexor hallucis longus travel
in a bundle along this pathway, through the tarsal tunnel.
In the tunnel, the nerve splits into three different paths. One
nerve (calcaneal) continues to the heel, the other two (medial and
lateral plantar nerves) continue on to the bottom of the foot.
The tarsal tunnel is made up of bone on the inside and the flexor
retinaculum on the outside.
TARSAL TUNNEL SYNDROME

Tarsal tunnel syndrome (TTS) entrapment of

the posterior tibial nerve as it descends from the
leg to the foot.
This condition was first described by Keck and
Lam in 1962.
The terminal aspect of the posterior tibial nerve
(L4-S1 nerve distribution) supplies
the motor function to the muscles of the foot and
the sensory innervation to the bottom of the foot.
Varying degrees of entrapment of this nerve may
effect either motor function, sensory function or
both.
ETIOLOGY
Contributing factors that may cause tarsal
tunnel syndrome include :
trauma to the tarsal canal,
varicose veins,
bone spurs and soft tissue tumors such as ganglionic
cysts.
biomechanical instability of the foot caused by
pronation (flattening of the arch) and supination
(high arch).
Each of these contributing factors ultimately results
in compression of the posterior tibial nerve.
The site where the nerve is compressed is also called
an entrapment.
 Patients complain typically of :
numbness in the foot,
radiating to the big toe
and the first 3 toes,
pain,
burning,
electrical sensations,
tingling over the base of the foot and the
heel.
 SYMPTOMS

Some of the symptoms are:

Pain and tingling in and around ankles and sometimes the toes
Swelling of the feet
Painful burning, tingling, or numb sensations in the lower legs. Pain worsens and spreads
after standing for long periods; pain is worse with activity and is relieved by rest.
Electric shock sensations
Pain radiating up into the leg, and down into the arch, heel, and toes
Hot and cold sensations in the feet
A feeling as though the feet do not have enough padding
Pain while operating automobiles
Pain along the Posterior Tibial nerve path
Burning sensation on the bottom of foot that radiates upward
"Pins and needles"-type feeling and increased sensation on the feet
A positive Tinel's sign
Tinel's sign is a tingling electric shock sensation that occurs when you tap over an affected
nerve. The sensation usually travels into the foot but can also travel up the inner leg as
well.
DIAGNOSIS

Diagnosis is typically made by

a physical therapist,
podiatrist,
neurologist,
physiatrist,
radiologist,
family practice doctor,
chiropractor, or orthopedist.
Patients' report of their pain and a positive Tinel's sign are the
first steps in evaluating the possibility of tarsal tunnel syndrome.
Nerve conduction studies are not common, but may be used as
clinical diagnosis is possible. .
Varicose veins within the tunnel are a common cause.

TREATMENT

Treatments typically include :

rest, manipulation, strengthening of tibialis anterior, tibialis
posterior, peroneus and short toe flexors,
casting with a walker boot,
corticosteroid and anesthetic injections,
hot wax baths, wrapping, compression hose, and orthotics.
Medications may include various anti-inflammatories,
Anaprox, Ultracet, and Neurontin and Lyrica. Lidocaine
patches are also a treatment that helps some patients.
If non-invasive treatment measures fail, surgery may be
recommended to decompress the area.
PROGNOSTICS
Many patients report good results.
Tarsal tunnel can greatly impact patients'
quality of life.
Depending on the severity, the ability to
walk distances people normally take for
granted (such as grocery shopping) may
become compromised.
Proper pain management and counseling is
often required.