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Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is similar to a carpal tunnel syndrome in the wrist area. In other words, it is a nerve entrapment compression.

The posterior tibial nerve (thanks to www.aafp.org for the image) passes through the tarsal tunnel, which is a tunnel-like structure below the medial ankle. It can be compressed due to various reasons and cause pain on the inside of the ankle (thanks to www.footeducation.com for the images). Various conditions could bring this on such as abnormal foot motions, arthritis of the ankle, flexor tendinitis or venous insufficiency with associated swelling (edema).

Ankle pain gets worse with walking and standing, and radiates into the toes. There is worsening of the pain with tapping below the medial ankle (called “Tinel sign“; thanks to www.yourmedicaldetective.com for the link). Electromyography shows exactly where the blockage is located and this needs to be done before surgery would be contemplated. If nerve entrapment is proven by EMG studies, no time should be wasted to have a surgeon do a surgical release, so that the nerve does not get damaged permanently through nerve atrophy. This surgery is called tarsal tunnel release.

 

References:

1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 5.

2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 270.

3. Wheeless’ Textbook of Orthopaedics: http://www.wheelessonline.com/

4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 60, p.487.

5. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

6. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

7. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

Last modified: November 13, 2014

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.