Tarsal Tunnel Syndrome
Tarsal Tunnel Overview
Tarsal Tunnel Syndrome (TTS) is a name for a group of problems that includes swelling, pain, tingling and loss of strength in your foot and ankle. TTS is a nerve disorder caused by the compression or damage to the posterior tibial nerve. This can occur from damaged tissue or bone inside or outside of the tarsal tunnel (aka tarsal canal). The tarsal tunnel runs through a small space along the inside of your ankle into the heel and sole of your foot. This condition is slowly progressive and occurs more commonly after 30 - 40 years of age. It causes a lot of pain in your foot, ankle and toes.
Often damage to your posterior tibial nerve in one location affects the overall functioning of your nerve, so you are more at risk of suffering from compression in other areas along the nerve.
Tarsal tunnels are narrow spaces in your ankle where nerves and tendons pass through from inside your leg to attach to bones on their way down to each toe.
The nerve sends signals along its length and also carries its own nutrients, which is necessary for optimal function. Nutrients move along the entire length of your nerve via axoplasms (jelly-like material inside the axons). If the flow of these nutrients is blocked, your nerve tissue does not receive necessary essential nutrients to stay healthy and fight off injuries - even beyond the area of compression. Without essential nutrients, damage, pain and inflammation will worsen and may extend further along the foot.
Similar conditions and other names for tarsal tunnel syndrome include: tarsal tunnel neuropathy, entrapment neuropathy of the tibial nerve, posterior tibial neuropathy, compression of the tibial nerve, and posterior tibial neuralgia. Tarsal tunnel syndrome (TTS) is similar to carpal tunnel syndrome, which occurs in your wrist, however it is far less common.
Tarsal Tunnel affects about 2% of adults aged 50 years or older.
Anatomy of the Tarsal Tunnel
The tarsal tunnel is found between the thick, overlying fibrous tissue on one side of your foot and the underlying bones. The flexor retinaculum acts as the top of your tarsal tunnel. It forms a deep, band of fibrous connective tissue that surrounds the muscles and nerves in your lower leg and ankle. The top of the calcaneus (heel bone), the inner wall of the talus (2nd largest tarsal bone that forms the ankle joint connecting the leg bones to the foot bones) and the inner/bottom part of the tibia (shinbone) comprise the bottom of your tarsal tunnel. Your ankle tendons, nerves, arteries and veins pass through the tarsal tunnel to get to the bottom of your foot.
The posterior tibial nerve is found between the posterior tibial muscle, the flexor digitorum longus, and the flexor hallucis longus muscles in your lower leg/ankle. The tibial nerve moves behind the bump on the inside of your ankle (medial malleolus) and through the tarsal tunnel, where it then divides into nerve branches in the sole of your foot.
Causes of Tarsal Tunnel
Any compression or entrapment of the posterior tibial nerve in the tarsal tunnel can cause tarsal tunnel syndrome. This may occur with:
- Swelling due to diabetes.
- Degeneration and/or swelling in the ankle joint from conditions such as arthritis.
- An ankle sprain or other ankle injury can cause swelling near the tarsal tunnel.
- Flat feet, or fallen arches, result in an outward tilting of the heel and can compress the tibial nerve.
- Varicose veins, a ganglion cyst, bone spur, or other abnormal growth can cause the space in the tarsal tunnel to tighten.
- Any other lower foot deformity can increase tension in the foot and may instigate the symptoms of TTS.
- Nerve damage already present in the ankle.
Symptoms of Tarsal Tunnel
Although they vary from person to person, most of these symptoms are generally experienced on either the inside of the ankle and/or the bottom of the foot. The most common symptoms noted by those who suffer from Tarsal Tunnel Syndrome are:
- A tingling, burning, or prickling sensation, also known as paresthesias, in your foot (often in your arch, toe or heal).
- Vague or sharp pain, near the area where the nerve is squeezed (often in the sole of your foot, near your big toe, or along your nerve); this pain tends to be worse at night. Pain can also manifest in the calf muscle or the arch of the foot.
- Numbness, a loss of sensation in the area of skin that is supplied by the nerve.
- Atrophied (weakened) muscles in your inner foot (around the ball or arch of your foot) can affect your gait (the way you walk). You may have a tendency to overpronate (your foot rolls inward too much), limp or feel uncoordinated as a result of too much pressure being placed on your foot.
You can feel these symptoms on their own in one location or in various locations across your foot and lower leg. They can be aggravated by overuse of your foot through walking, exercising or prolonged standing. These symptoms will often subside with rest however they will not disappear.
If left untreated, you are at risk of suffering from permanent nerve damage.
How Does Foot or Ankle Tendonitis Relate to Tarsal Tunnel Syndrome?
Tendonitis is a condition where your tendon becomes irritated or inflamed. Usually this irritation, swelling and inflammation happens because of some kind of damage or micro-tear occurring within the tendon. This can happen from overuse of the tendon or an accident of some kind.
Foot and ankle tendonitis (posterior tibial tendonitis) can cause tarsal tunnel syndrome, especially if the tendon affected runs inside or alongside of the tarsal tunnel. If this happens, the swelling and inflammation from the tendinitis will squeeze the tibial nerve running through the tarsal tunnel and trigger a TTS injury.
What's the Difference Between Tendonitis, Tendinosis and Tenosynovitis?
Tendinosis is similar to tendonitis but this condition is not caused by an injury. Tendinosis occurs as a result of chronic degeneration (wear & tear) of tendon fibers. This happens naturally as we age. Tendonitis is triggered due to damage or micro-tearing to the tendon, tenosynovitis is caused by damage or micro-tearing to the sheath covering the tendon. The sheath protects the tendon and is made of synovium (a special type of connective tissue).
It's possible for you to have tendonitis / tendinosis AND tenosynovitis at the same time, creating a more complicated injury.
How Does A Sprained Ankle Relate to Tarsal Tunnel Syndrome?
A sprained ankle is a stretch and/or tear affecting one or more of the ligaments in your ankle. This common injury occurs after the foot twists, rolls or turns inward beyond the normal range of motion. Thousands of people suffer from the pain of a sprained ankle every day. There are 7 different kinds of ankle sprains:
- High Ankle Sprain
- Lateral Sprain
- Inversion Sprain
- Eversion Sprain
- Syndesmosis Sprain
- Anterio Talofibular Ligament Sprain
- Anterior Inferior Tibiofibular Ligament Sprain
Swelling and inflammation from an ankle sprain can also cause tarsal tunnel syndrome by compressing the tibial nerve in the tarsal tunnel. Relief of the swelling and inflammation through cold compression and conservative treatments at home can help release the pressure placed on the tibial nerve.
How Severe is Your Sprained Ankle Injury?
Sprains are typically categorized according to severity:
- MILD (Grade 1): 1 or more ligaments in your ankle are stretched in a mild sprain, but there is no joint loosening.
- MODERATE (Grade 2): 1 or more ligaments in your ankle are partially torn, producing joint instability and some swelling.
- SEVERE (Grade 3): 1 or more ligaments in your ankle are torn completely, separated from the bone and causing you excruciating pain. This is a complete rupture of the ligament(s) and can make your ankle joint nonfunctional.
Tarsal Tunnel Treatment Options
The most important factor in dealing with Tarsal Tunnel Syndrome is resting your ankle. This can be difficult when you have to carry on with daily activities, but resting and elevating your foot whenever you can is recommended. During your recovery you will probably have to modify or avoid the activities that put stress on your ankle until your pain and inflammation settle.
Although steroid injections may provide temporary relief from the pain of an a soft tissue injury in the achilles and heel, they should generally be undertaken with caution as they weaken strained tendons... and may lead to a complete rupture. If you do opt for an injection, doctors usually recommend that you do not participate in strenuous activities for several weeks to reduce the risk of a rupture.
If conservative treatments do not help, surgery may be necessary to remove scar tissue near nerves in order to decompress them - this will help relieve symptoms and clear up the condition unless there has been permanent nerve damage.
Conservative Treatment Step 1: Reduce The Initial Inflammation
Inflammation is often a causal factor with tarsal tunnel, and is often a response to an immediate ankle injury and is a normal part of the healing process - helping to reduce tissue infection in the early stages of injury. Swelling, pain, heat sensation, redness, and loss of function are the main symptoms experienced.
Cold Compression will reduce pain, inflammation and swelling in your ankle to treat tarsal tunnel causes and symptoms. Note that the importance of using a cold pack is very high, though when surveyed, most TTS sufferers never take advantage of this easy treatment step. By limiting the amount of damage done to your posterior tibial nerve, you also reduce pain and limit the amount of healing that needs to occur. This is a very important step to get rid of tarsal tunnel syndrome faster and with less pain!
Applying cold to your affected ankle will decrease the swelling and redness at the injury site. In addition, it will numb the pain in your ankle and help to control the inflammation. Simply, apply cold to your ankle as needed throughout the day, for approximately 10-15 minutes at a time.
The combination of rest, topical pain relief cream and cold is the gold standard in medicine for minimizing tissue damage, reducing heel pain and reducing inflammation after injury or activity.
Conservative Treatment Step 2: See Your Physician & PT
Your PT will most likely assess your specific biomechanics and attempt to correct them if they are determined to be causal factors to your condition. Further to this, some causal factors may require surgery so it is important to get to your doctor and have it checked out. Stretching and strengthening exercises, centered on the lower leg and ankle will probably be assigned to you by your physical therapist as well.
Conservative Treatment Step 3: Enhance Blood Flow to the Ankle
Once the inflammation in ankle has calmed down after, nourishing and strengthening the injured soft tissue is recommended. At home, this can be achieved by boosting blood flow in the area.
TShellz Wrap®: Designed to Boost Blood Flow To The Treatment Area
If you want to heal quickly, you need to keep your blood moving and that's where TShellz® Circulatory Boost Wraps come in. What is Circulatory Boost? It's a substantial increase in the flow of blood to soft tissue without the need to exercise your weakened joint. This is what the TShellz Wrap® does... you can really feel it work!
Have you seen what happens when you add water to a flower wilted from drought? An injured muscle is kind of like a "wilted" flower - your body wants to heal the injury but needs lots of nutrients to do it. Blood supports and facilitates new life by delivering healing nutrients and oxygen that are vital for the growth and repair of soft tissue. Furthermore, an increased blood flow is more effective at carrying away toxins and waste - this all adds up to increased capability of your body to heal soft tissue. Without a good supply of blood, damaged soft tissue simply will not heal in a timely fashion.
In order to get maximum blood flow to your foot and surrounding soft tissue, you need to help your body stimulate blood flow - you need a TShellz® Circulatory Boost Wrap. A Localized Enhanced Circulatory Response® Treatment is intended to be fastest and easiest pain-free way to increase localized blood flow and is a key part of MendMeShop's home conservative treatment plan.
A Localized Enhanced Circulatory Response® Treatment is Achieved Via the TShellz Wrap®
During a treatment, and for quite some time after you finish, the treated area will experience increased blood flow even though your body is at rest. It's a soothing sensation and extremely effective. With a TShellz Wrap® application, injured soft tissue is constantly being fed with healing, nutritious, oxygen and energy filled blood. This is exactly the fuel that soft tissue needs to heal.
How A TShellz Wrap® Works
A TShellz Wrap® is purely a Circulatory Boost workhorse! It is why we made them. They have been specifically designed for boosting blood flow, reducing inflammation and relieving pain from strained, spasming or damaged soft tissue (muscles, bursae, tendons, etc). Based on results from past clients, we are confident that they will be very beneficial for most of our future customers.
TShellz Wraps® contain an Energy Pad which is very pliable and will conform pretty much anywhere on the body. The Energy Pad emits a uniform wave of energy over the entire treatment area. This energy travels into soft tissue, stimulating blood flow that your body requires to help heal your injury. Blood flow is crucial to the healing process.
Increased Blood Flow = More Oxygen, More Nutrients and Less Toxins in Soft Tissue
The unit plugs into a wall outlet to get its power. It has a special signal controller which can be set for 3 different power levels of application (3=High, 2=Medium, 1=Low). The cord is long enough that you can sit or lie comfortably and watch TV, read or surf the net while you're using it.
Both during and after the treatment, soft tissue (muscle, tendons, ligaments, bursae) will experience an increase in blood flow even though your body is at rest.
Recognize That Healing is a Process
With dedication, the right tools, and the right information - you will achieve your goal of a sustainable recovery. A combination approach of cold and heat treatments, and functional movements will make it happen much more quickly. Healing takes a comprehensive approach and will differ from person to person.
If you have questions, we welcome you to call our office toll-free at 1-866-237-9608 (Continental US), or Internationally at +1-705-532-1671.
Anti-inflammatory medications can be used to reduce inflammation in the tarsal tunnel and reduce TTS symptoms. However, often this method is usually only somewhat effective for mild cases of TTS and does not heal the damaged tissue. As a result, tarsal tunnel syndrome patients who only use anti-inflammatory medications as treatment find their TTS returns again and again. It is important to heal the tissue surrounding your tarsal tunnel to avoid the symptoms worsening and increasing the chance of surgery being required.
Although pain killers provide some relief they will only mask the symptoms of TTS and are a temporary solution. As well corticosteroids and diuretics that reduce swelling have been found to be temporary pain solutions and do not treat the syndrome at the source.
Making some changes in your lifestyle can help reduce the symptoms of tarsal tunnel syndrome and reduce the risk of it returning.
- Staying healthy and treating any conditions that might increase your risk of TTS, like diabetes, arthritis and thyroid disease, can help.
- If your work, hobbies or daily tasks are causing more strain on your foot try reducing your movements or sit to perform your tasks if possible.
- Stretching or flexing your foot, knee and legs regularly throughout the day can help maintain more flexible joints and increase the flow of blood to your foot.
In more severe cases of tarsal tunnel syndrome, surgery may be required to release the flexor retinaculum to relieve the pressure on the tarsal tunnel. This type of surgery is done without a stay in the hospital and usually only requires a local anesthetic. Unfortunately the results are not guaranteed; symptoms may continue for several months and/or return. As well, recovery time can be a few weeks or months and can disrupt your work, hobbies and daily activities.
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