Tarsal Tunnel Syndrome: Symptom, surgerical procedure for release of the syndrome.

Surgery Tarsal tunnel Syndrome

Tarsal tunnel syndrome

Tarsal tunnel syndrome is a painful condition caused because of trapping of the tibial nerve. The tibial nerve is one of the main innervating nerves of the foot and ankle, it travels along the tibia curving downwards on the posterior side of the leg to reach the ankle. This region of the foot contains four compartments three of which are comprised of muscle insertions from the leg , whereas the fourth contain the tibial nerve and the posterior tibial vein and arteries. At the top of all these structures lies the laciniate ligament, which forms the cover of these compartments. This area is so compact that any sort of enlargement or intrusion of foreign bodies into this area may cause unwanted pressure on the area occupied by the tibial nerve and entrapment occurs, this is tarsal tunnel syndrome. This casues pain, and a burning sensation and tingling along the sole of the foot, this pain generally progresses in intensity as the day progresses because of fatigue and is relieved by rest, elevation and massage. The syndrome was found to be most commonly affecting active adults. The burning and tingling it causes is a result of a compressed tibial nerve attempting to communicate between the foot and the brain. This compression that occurs may also be a direct result of the overgrowth of an adjacent muscle that may apply force on the tarsal nerve hence causing the sensations of pain, burning and tingling. People with flat feet are generally considered to be more susceptible to tarsal tunnel syndrome as the flattened foot arch causes strain on the muscles and nerves surrounding the ankle, changing there route and hence causing compression of the tarsal nerve. Rarer cases have been reported as a result of diseases such as rheumatoid arthritis and diabetes which are systemic in nature as well as compressions caused by a cyst. Trauma or fractures of the heel and ankle can also eventually lead to tarsal tunnel syndrome. This is because as healing occurs scar tissue forms and this scar tissue takes up space causing the eventual entrapment of the nerve.

There are two treatment protocols for tarsal tunnel syndrome conservative and surgical. The conservative treatment entails the use of arch supports and wider shoes , NSAIDS are frequently prescribed to ease the pain. Steroid injections have provided relief to patients, but care must be taken to avoid any eventually injury to the surrounding structures of the fourth compartment, such as the tibial veins and arteries. If the etiology of the syndrome is definitively flat feet, then specially made orthotics can help in restoring the foots natural arch and alleviate the symptoms. if he conservative treatments prove to be ineffective surgical treatment is required. The procedure involves an incision being made right posteriorly and inferiorly to the medial part of the ankle, the surgeon then has direct line of sight towards the lacinate ligament, and he cuts it. This provides room for the expansion of the nerve. If a cyst is found to be the culprit then its resection leads to symptom free progression.