tarsal tunnel syndromeTarsal tunnel syndrome is a condition in which the tibial nerve, located in the tarsal tunnel in the foot, which is behind the ankle joint, is compressed. More importantly, the nerves just below the tunnel usually are more of the problem and these include the medial plantar nerve, the lateral plantar nerve and the medial calcaneal nerve.

The tibial nerve can become compressed from injury, such as an ankle sprain and flat feet. Arthritis, diabetes, and varicose veins can also cause swelling and thus result in nerve compression. Symptoms of tarsal tunnel syndrome include several different sensations in the sole of the foot, inside the ankle, and around the tibial nerve. These sensations include shooting pains, numbness or reduced sensation, pins and needles, burning, and tingling, cramping. Symptoms tend to worsen with greater activity to the area. In rare and severe occasions, this can change the muscles in the foot.

A very important fact to keep in mind when looking at the symptoms of tarsal tunnel is that they are not the same every day. Nerves are very sensitive to many different situations. They can be more severe one day and very mild the next day and you may not remember or be aware of what made them change. This can depend on the weather, your activity, your hydration, medications you take, your metabolic status, stress level and many more causes. This causes the nerves to be variable and unpredictable. A common statement is that, "The pain or symptoms are always there, but it is just how bad is it today"

If you suspect you have tarsal tunnel syndrome, you should consult with Dr. DiNucci. He has more experience than anyone else in Nebraska when it comes to nerve entrapments in the lower extremity. He will examine your medical history to see if you have a history of diabetes, arthritis, or flat feet. He will also check to see if you have suffered an injury to the area recently. In most cases a nerve conduction study is not performed since they are not accurate in the lower extremity and are the results are not consistent. A nerve conduction study will tell us if you have a nerve problem. Chances are that if come in and tell your doctor you have tingling, numbness and burning in the feet, that you have a nerve problem. We don't need an expensive test to tell us that. A simpler Tinel’s Test might also be used. This includes simply tapping the nerve to create a sensation. If this is positive then the nerve is irritated and usually means it has the capacity to regenerate. People who have a positive tinel's sign have up to an 85% chance of relief of decompression of their nerves surgically.

Treatments vary greatly for tarsal tunnel syndrome however the gold standard at this time is to decompress the nerves surgically while they are still alive and keep them from dying. Once the nerves have died, they are not sending signals to your brain to tell you where your feet are. This can compromise your balance, cause falls which can cause other injuries. This can also make you susceptible to injuries to your skin. Not feeling your skin means you may not feel when you have a cut or scrape and this can lead to ulcerations or infections. This is most commonly found in diabetics who have had nerve damage.

In the most recent literature, there is evidence that decompression of the nerves in diabetics can decrease the chances for amputation and ulcerations significantly. This is true even when the diabetics have advanced nerve disease and have had ulcerations.

There are many older treatments that have been postulated in the past that are not found to have significant relief of this condition. In fact most conservative treatments will not work and only prolong the condition and allow the nerve to die. Surgical decompression of the nerves is the gold standard for treatment.

Orthotics are usually not indicated in people who have tarsal tunnel syndrome. This is a simple concept to look at. The nerves are inflamed and irritated. You now put an arch support under the foot that is supposed to be high enough to put increased pressure on the arch. This causes increased pain and usually when someone has this condition they cannot tolerate a supportive orthotic or a supportive shoe for more than a short period of time. They keep searching for an answer with mechanical relief whether it's a different shoe or arch support, but they usually don't work. The most effective over-the-counter orthotic is The Foot Chair.

Surgical options include a tunnel tarsal release, in which an incision is made behind the ankle down to the arch of the foot. This releases the ligament and all compartments that the nerves are found coursing through. This relieves pressure off the nerve.

If you are suffering from painful sensations in your foot, see Dr. DiNucci and he will be able to determine if you are experiencing tarsal tunnel syndrome. Tarsal tunnel syndrome that is left unchecked can cause permanent nerve damage to the foot.

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