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The tarsal tunnel is a narrow, rigid passageway located on the inside of the ankle, just below the medial malleolus (the bony prominence on the inner side of the ankle). It’s formed by ankle bones and the flexor retinaculum, a band of connective tissue that holds the structures in place. Inside, it houses the tibial nerve, which supplies sensation and muscle control to the foot; the posterior tibial artery and vein; and tendons of the flexor muscles.
Tarsal Tunnel Syndrome is a condition which occurs when the tibial nerve is compressed as it travels through the tarsal tunnel. It is similar to carpal tunnel syndrome, but affects the ankle instead of the wrist.
Signs and Symptoms of Tarsal Tunnel Syndrome
Pain: Typically manifests as a burning or shooting sensation, which may extend from the ankle into the foot.
Tingling and Numbness: Commonly experienced in the bottom of the foot and the toes.
Swelling: The ankle or foot may show signs of swelling.
Weakness: In more severe cases, there might be muscle weakness in the foot, affecting walking or standing.
Altered Sensation: The affected areas might have decreased sensitivity or a "pins and needles" feeling.
Causes of Tarsal Tunnel Syndrome
Causes of Tarsal Tunnel Syndrome
Compression of the tibial nerve at the tarsal tunnel can occur due to several factors, including flat feet, which is associated with overpronation and abnormal foot biomechanics that increase pressure on the nerve; inflammatory conditions such as arthritis, which can lead to swelling and pressure in the tarsal tunnel; cysts or tumors that may grow in the area and compress the nerve; and trauma from direct injury to the ankle or repetitive stress.
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Risk Factors of Tarsal Tunnel Syndrome
Foot Structure: Flat feet caused by excessive pronation can create strain and compression on the nerve.
Diabetes: This condition can lead to nerve damage and increase the risk of neuropathies.
Arthritis: Swelling in the surrounding joints can elevate pressure in the tarsal tunnel.
Obesity: Excess weight can put additional stress on the feet and ankles.
Overuse: Repetitive activities or sports that stress the ankle may increase the risk.
Treatment and Management of Tarsal Tunnel Syndrome
Depending on the cause of tarsal tunnel syndrome, treatment aims to identify and address the underlying issue, which will reduce compression on the tibial nerve and alleviate symptoms.
Footwear Changes: Wearing supportive shoes with proper support and cushioning to reduce pressure on the tarsal tunnel.
Custom Foot Orthotics: Aim to correct foot mechanics and relieve pressure on the nerve.
Lower Limb Exercises: Aim to strengthen the muscles around the ankle, improve flexibility, and reduce strain on the tarsal tunnel.
Surgical Treatment: If conservative treatments are ineffective, surgical options may be considered. This involves relieving pressure on the tibial nerve by releasing the surrounding structures causing compression.
A comprehensive treatment plan should be tailored to each individual's needs and may involve a combination of these approaches to effectively manage and alleviate symptoms of tarsal tunnel syndrome.
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