Tarsal Tunnel Syndrome

You don’t have to live with the pain.

According to Robert P. Dunne, DPM, a board-certified podiatric surgeon at Lake Washington Foot & Ankle Center, “Tarsal tunnel syndrome, or TTS, presents itself when nerves in the ankle, such as the tibial nerve, are compressed.Stock photo from istockphoto.com
“TTS can have several different catalysts or triggers,” he continues. “Symptoms can be of a sudden onset or can gradually get worse over time. TTS can be the result of trauma or a congenital disease.”
Arthritis is a typical cause of TTS. It causes swelling, which in turn compresses the nerves. Like arthritis, diabetes also causes swelling that squeezes the nerves. The soft tissue swelling from sprains and strains will also create pressure on the nerves.
Other causes include flat feet, or fallen arches; scar tissue from a prior surgery or trauma, or varicose veins. Cysts or spurs can also compress the nerves and produce symptoms.
“When the symptoms initially present themselves, it is important to seek treatment,” cautions Dr. Dunne. “Immediate treatment of TTS can prevent permanent nerve damage and possibly reduce the need for surgical correction. Often, when a patient with TTS presents to the office for the first time, he or she will report symptoms similar to those of carpal tunnel in the hand,” says Dr. Dunne.
Symptoms of TTS may include tingling or burning. Sometimes, sufferers experience numbness, or loss of sensation, in the affected foot, particularly in the first and second toe, and the ankle. Others experience symptoms such as shooting or stabbing pains so pronounced that these sensations interfere with their day-to-day lives. Occasionally, these symptoms can be accompanied by weakness and the sensation that the ankle or foot could be “giving way.” Patients may also experience symptoms that are worse at night, radiate into the calf and can be aggravated by prolonged standing or walking.
Fortunately, Dr. Dunne and Lake Washington Foot & Ankle Center can help with the management and treatment of TTS, giving the patient several treatment options. These range from conservative to invasive in nature.

Diagnosing and Treating TTS

TTS is diagnosed in several ways. At Lake Washington Foot & Ankle Center, patients receive an extensive exam by
Dr. Dunne, including a superficial testing of the nerves, a complete medical history and, depending on symptoms and history, x-rays. In some cases, Dr. Dunne will send the patient to a neurologist to have nerve conduction studies to learn if the patient’s symptoms are a result of TTS, or if there is another cause for the patient’s discomfort.
Lake Washington Foot & Ankle Center can offer TTS treatment that will vary with the patient’s needs and symptoms. In some cases, symptoms can be temporarily relieved through massage, rest and elevating the affected ankle.
“There are several treatment paths we can take with our patients, depending on symptoms, severity and length of discomfort,” notes Dr. Dunne. “Our first option is always conservative treatment.”
Conservative treatments might include custom-molded orthotics, ankle braces or splints. Oral anti-inflammatories may be used, as well as topical anti-
inflammatories. Another option is physical therapy, including stretching and strengthening techniques.
A minimally invasive approach involves the use of cortisone, or steroid injections. The most invasive treatment is surgical correction using a procedure called tarsal tunnel release.
“Seeking treatment at the first sign of symptoms will make the outcome of the treatment more successful and reduce the amount of permanent nerve damage,” observes Dr. Dunne. “Again, earlier treatment can reduce or eliminate the need for surgical intervention in some cases.”
Lake Washington Foot & Ankle Center is a comprehensive podiatric medicine clinic. It offers treatment for everything from bunions to hammertoes to neuromas to diabetic complications.

Article courtesy of Lake Washington Foot & Ankle Center
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