While tarsal tunnel syndrome is due to a nerve entrapment in the ankle/foot area, this is similar to a carpal tunnel syndrome in the wrist area.
With this in mind, it is the posterior tibial nerve that passes through the tarsal tunnel, which is a tunnel-like structure below the medial ankle. It can be compressed owing to various reasons and cause pain on the inside of the ankle. In other words, various conditions can bring this on such as first, abnormal foot motions, second, arthritis of the ankle and third, flexor tendinitis or venous insufficiency with associated swelling (edema).
Tarsal tunnel release
Notably, ankle pain gets worse with walking and standing, and by and large radiates into the toes. For the most part, there is worsening of the pain with tapping below the medial ankle (called “Tinel sign“). In any event, electromyography shows exactly the location of the blockage. Obviously, the surgeon orders this electrophysiological procedure before any planned surgery. Ultimately, if nerve entrapment is proven by EMG studies, no time should be wasted to have a surgeon do a surgical release. In this case, 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
