What is Tarsal Tunnel Syndrome?
Tarsal Tunnel Syndrome is an inflammation caused by compression or tension on the large sensory nerve behind the ankle and in the arch. The compression of this nerve is usually caused by the surrounding anatomic structures of the medial ankle. The most common is the large ligament that holds the tendons in place behind the ankle. When the limited space under the ligament is taken up by other structures (as in swelling of the tendon in tendinitis or swelling of the veins commonly seen in pregnancy), the nerve experiences compression. When the foot biomechanics is at fault, there is flattening of the arch and because of the position of the foot in relation to the ankle, the course of the nerve is lengthened. This causes mechanical stretching of the nerve.
When these conditions exist, the nerve reacts by causing a combination of symptoms including tingling, burning, numbness, sharp/shooting electric sensations into the bottom of the foot, arch and toes and possibly radiating up the ankle and into the leg.
Conservative treatment for this condition is the same as that for Plantar Fasciitis and Neuroma. As for surgical treatment, this is more difficult. Care must be taken to minimize scar tissue formation after the procedure so the symptoms do not return. At this time, the more minimally invasive procedures of Cryoanalgesia and Nerve Decompression are successful options for treatment. At azcryo, we perform the cryo procedure in the office after a full work-up and conservative course. The nerve symptoms are localized to the smallest nerve branch involved and using ultrasonic guidance of the probe onto that smallest nerve branch, the six minute procedure is performed under local anesthesia. Healing of the incision and return to full activity is within days of the procedure.
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