By: Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN
I get this response frequently from my patients. Almost everyone is familiar with their carpal tunnel as it seems either they or someone in their family suffers from or has had surgery to correct that all too familiar condition that has exploded directly proportional to the use of computers and the transition to a "paperless" society. Tarsal tunnel is its long lost relative, affecting the feet in a similar fashion, causing numbness, burning, and shooting pain along the inside and bottom of the foot.
The tarsal tunnel refers to the canal formed between the medial malleolus (bump on the inside of the ankle) and the flexor retinaculum (a ligamentous band that stretches across the inside of the foot). The nerves, arteries, and tendons that provide movement and flexibility to the foot course through this tunnel.
The tibial nerve travels through this tunnel and provides sensation to the bottom of the foot. When tibial nerve is compressed, the resulting condition is called tarsal tunnel syndrome or posterior tibial neuralgia.
Strain or compression on the tibial nerve caused by injury, disease, or due to the natural shaping of the foot can lead to tarsal tunnel symptoms. Acute injury such as swelling caused by an ankle sprain, or chronic/repetitive issues such as having flat feet or fallen arches can lead to compression over time. Diseases such as arthritis, diabetes, or even lymphedema, which can cause swelling, can result in nerve compression.
Although symptoms may suggest tarsal tunnel syndrome, proper diagnosis may indicate specialized testing such as EMG or nerve conduction study, and/or imaging such as X-rays, CT, or MRI scans to confirm. Proper diagnosis is necessary to determine the severity of the condition, so the appropriate treatment plan, including both surgical and nonsurgical options, may be considered.
Possible treatment options may include physical therapy to help decrease inflammation using anti-inflammatory modalities such as phonophoresis or iontophoresis, in which an anti-inflammatory medication is delivered into the nerves in the tarsal tunnel. This may help to relieve pressure and swelling. Orthosis (e.g., braces, taping, splints, orthotic devices) may be recommended to reduce pressure on the foot and limit movement that could cause compression on the nerve. Depending on the mechanical nature or cause of the issue, manipulation, soft tissue mobilization, stretching or strengthening activities may be prescribed to assist with improving biomechanics to limit excessive loading with daily activities.
If the condition is severe, your doctor may give you a steroid injections or may suggest surgical options if deemed appropriate or if conservative measures have been unsuccessful. Tarsal tunnel release procedures are common and provide significant relief in some cases. Your health care providers will be there to discuss your diagnosis and treatment so that you can make an informed decision on the direction of your treatment.
At Professional Rehabilitation Services we pride ourselves in distinction and are continuously in pursuit of specialty training to provide our patients with a higher level of care. One of our Board Certified Orthopedic Physical Therapists will pursue an individualized treatment approach to your needs. Less than 5% of physical therapists in South Carolina are board certified in orthopedics. If you or someone you know lives with a similar problem and would like to know more, then you can contact Richard A. Owens, PT, MS, OCS, Cert. SHT, CWcHP, Cert DN (Surfside Beach) (843) 831-0163, Richard DeFalco, DPT, OCS, CSCS, CWcHP, Cert. DN (Myrtle Beach) (843) 839-1300, Brian P. Kinmartin, PT, DPT, MTC, OCS, STC, CWcHP, Cert. DN, (Pawleys Island) (843) 235-0200, or Kristen Lies PT, DPT (Murrells Inlet) (843) 314-3224 for a free 15 minute consultation to determine whether physical therapy is an option for you. You can also visit our website www.prsrehabservices.com where you can learn more about the company and even print a referral for your physician to fill out.