Tarsal tunnel syndrome

Tarsal tunnel syndrome, also called tarsal tunnel syndrome, is a nerve compression to the inside of the hind foot. Tarsal tunnel syndrome is a pinch of the tibial nerve where it passes through the tarsal tunnel. This can cause sharp, severe pain in the area.

The tarsal tunnel can be found on the inside of the medial malleolus (the big bullet on the inside of the ankle). The posterior tibial artery, the tibial nerve, and the tendon attachments of the posterior musculus, flexor digitorum longus (toe flexor) and flexor hallucis longus (major toe flexor) are all structures that pass through the tarsal tunnel.

Patients with this diagnosis experience characteristic numbness from the inside of the foot that extends toward the first 3 toes. This in combination with pain, a burning sensation, electric shocks and yelling at the base of the foot and heel may occur. The pain and symptoms will depend on where the nerve is pinched.

Scroll below for to watch two great training videos with exercises that can help with tarsal tunnel syndrome.

VIDEO: 5 Exercises for Pain in the Footstroke Due to Tarsal Tunnel Syndrome

Strengthening and improving the structures of the feet and ankles is essential in tarsal tunnel syndrome. These five exercises shown in the video below can help you improve ankle stability, increase shock load capacity and thus relieve the tarsal tunnel.

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VIDEO: 10 Strength Exercises for Your Hips

The hips are among your most important shock absorbers. Because both feet and ankles need increased stability and functional relief in tarsal tunnel syndrome, it is thus very important for you to strengthen your hips. This can help prevent further failure loads. Click below to watch the video.

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Causes of tarsal tunnel syndrome

It may be difficult to say the exact cause of tarsal tunnel syndrome, but the most common cause often comes from strong overpronation (when the arches fall inward) or pes planus (Flatfoot).

Repetitive strain on the ankle and foot, especially with regard to those affected by these misalignments of the feet, can cause a local swelling and pinching against the tibial nerve - something that can naturally occur in those who run a lot or athletes.

Other causes may be inflammation of the tissue surrounding the tarsal tunnel due to overcoating or ankle fractures, nerve cysts or ganglions (often seen in the hand as shown) here ), benign tumors or varicose veins.

We must keep in mind that lumbar prolapse can also cause similar symptoms as tarsal tunnel syndrome, but a clinician will be able to distinguish between the two during testing and examination - when there is pressure on two nerves, one in the back and one in the foot, this is called « double clamping ».

Those with the consept of rheumatism also has a higher incidence of tarsal tunnel syndrome.

Who is affected by tarsal tunnel syndrome?

Those who are active in sports, weightlifting and especially those with a high repetitive load on the ankle and foot are most exposed - especially if the majority of the load is on a hard surface. Feet defects (overpronation and flatfoot) can also be a contributing cause of developing tarsal tunnel syndrome.

- Here we see where the tarsal tunnel is located at the foot (see framed area). It thus lies on the inside of the ankle, below and on the back of what we call the medial malleolus. The tarsal tunnel has legs on the inside and the tissue structure flexor retinaculum on the outside.

Symptoms of tarsal tunnel syndrome

Pain and symptoms will depend on where the tibial nerve is compressed. This is because inside the tarsal tunnel, the tibial nerve divides into three branches - one goes to the heel and the other two (medial and lateral plantar nerve) go to the underside of the foot.

We must remember that the tibial nerve can also be clamped higher up into the calf or ankle and will then give symptoms below the area where the nerve compression occurs.

When the pressure on the nerve increases, the blood supply will decrease. Nerves respond to such pinching by changing sensory (the feeling you have in the skin) and you can thus experience both tingling and numbness - this is the same thing that happens with sciatica.

Accumulation of fluid and swelling can also occur around the squeezing - this in turn will aggravate the condition when walking and standing. When the muscles lose their nerve supply, this can also give cramp-like feelings.

Typical symptoms include:

- Pain and tingling around the inside of the ankle and foot

Swelling in the ankle and foot

- Burning sensation in the foot, ankle and calf

- Pain and tingling around the inside of the ankle and foot. The pain worsens when walking or standing.

- Electrical shock

- Heat rashes and cold sensation in the foot

- A feeling that the foot does not have enough 'shock absorption' on the underside of the foot blade

- Pain in the foot when driving a car and pedal use

- Pain along the tibial nerve pathway

- Positive result on Tinel's test (a simple orthopedic test that can test for nerve compression)

- Burning sensation under the sole of the foot that radiates further up the foot, lower leg and even towards the knee

- Pain and tingling around the inside of the ankle and foot

Diagnosis of tarsal tunnel syndrome

A clinical examination will be based on history and an examination. This will show decreased movement in the ankle and local tenderness over the affected area inside the ankle. A positive Tinel's test may indicate a nerve compression.

Further investigation will be done with imaging diagnostic tests. A nerve conduction test can confirm that there is a lack of nerve supply in the area. Other possible causes of similar symptoms are cuboid syndrome.

Imaging of tarsal tunnel syndrome (X-ray, MRI, CT or ultrasound)

An X-ray can rule out any fracture damage. One MRI examination can show if there are any ganglions, cysts or other structures that compress the tarsal tunnel - such an examination can also detect any tendon damage. Ultrasound can examine whether it is about synovitis or ganglions - it can also see if there is fluid accumulation in the area.

MRI of ganglion cyst in the ankle leading to nerve compression in the tarsal tunnel (tarsal tunnel syndrome)

- In the picture above, we see an MRI of the tarsal tunnel. In the picture we clearly see a cyst that puts pressure on the nearby nerve.

Treatment of tarsal tunnel syndrome

The main purpose of treating tarsal tunnel syndrome is to remove any cause of the compression and allow the area to heal itself - thus reducing both pain and inflammation. Cold treatment can provide pain relief for sore joints and muscles, also in the foot.

One should always try conservative treatment for a long time before resorting to invasive procedures (surgery and surgery), but in some cases this is the only way out. Direct conservative measures can be:

Exercises and stretching

- Weight reduction (this will reduce the pressure on the area)

- Nerve mobilization (a clinician can stretch the tibial nerve and release pressure around the compression)

- Physical treatment

What can I do even for foot pain?

1. General movement and activity is recommended, but stay within the pain limit. Two walks a day of 20-40 minutes make good for the body and aching muscles.

2. Trigger point / massage balls we strongly recommend - they come in different sizes so you can hit well even on all parts of the body. There is no better self help than this! We recommend the following (click the image below) - which is a complete set of 5 trigger point / massage balls in different sizes:

Affected by the troublesome foot disorder plantar fasciitis and heel spur? The balls are also particularly suitable for the treatment of these conditions!

3. Training: Specific training with training tricks of various opponents (such as this complete set of 6 knits of different resistance) can help you train strength and function. Knit training often involves more specific training, which in turn can lead to more effective injury prevention and pain reduction.

4. Pain Relief - Cooling: Biofreeze is a natural product that can relieve pain by cooling the area gently. Cooling is especially recommended when the pain is very severe. When they have calmed down then heat treatment is recommended - it is therefore advisable to have both cooling and heating available.

5. Pain Relief - Heating: Warming up tight muscles can increase blood circulation and reduce pain. We recommend the following reusable hot / cold gasket (click here to read more about it) - which can be used both for cooling (can be frozen) and for heating (can be heated in the microwave).

Recommended products for pain relief for foot pain

Biofreeze (Cold / cryotherapy)

If conservative treatment has no effect, then surgery may be necessary to release the nerve - cortisone injection can also be used, but it is also recommended as a last resort, as the chances are high that this can lead to late injuries in nearby tendons and soft tissue.

Exercises for tarsal tunnel syndrome

One should try to cut out too much weight-bearing exercise if one is afflicted with tarsal tunnel syndrome. Replace jogging with swimming, elliptical machine or exercise bike. Also, make sure that you stretch your foot and train your feet lightly as shown this article.

Related article: - 4 good exercises for sore feet!

NEXT PAGE: - Sore foot? You should know this!

Also read:

- Pressure wave treatment of plantar fascite

- Exercises and stretching of plantar fascia heel pain

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Training:

• Cross-trainer / ellipse machine: Excellent fitness training. Good for promoting movement in the body and exercising overall.
• Rowing Machines is one of the best forms of training you can use to get good overall strength.
• Spinning ergometer bike: Good to have at home, so you can increase the amount of exercise throughout the year and get better fitness.

Sources:
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Frequently asked questions about tarsal tunnel syndrome:

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