tarsal tunnel syndrome

Tarsal Tunnel Syndrome - Pain and numbness in the feet

On average, we put back about 10,000 to 15,000 steps a day, with full body weight resting on our feet. A guarantee for our locomotion is that the feet work well and painlessly. In the so-called tarsal tunnel syndrome, it comes here to disorders due to the compression of a nerve.

contents

• Tarsal Tunnel Syndrome - Pain and numbness in the feet
• definition
• Symptoms of nerve compression
• causes
• diagnosis
• Treatment of tarsal tunnel syndrome

definition

The tarsal tunnel syndrome describes a nerve compression in the area of ​​the tarsal tunnel, where the tibial nerve is superior. The tarsal tunnel is located at the medial malleolus under a retaining band (called the retinaculum musculi flexorum). The tibial nerve (called the tibial nerve) runs in it - and thus also under the ligament. This can be disconnected there, resulting in discomfort, pain and functional impairment.

Lesions and pain under the sole of the foot, which can radiate to the toes and lower leg, are possible signs of tarsal tunnel syndrome. (Picture credits: Lupo / pixelio.de)

Symptoms of nerve compression

Sudden pain and disturbances in sensitivity (paresthesia) with touch sensitivity, tingling and numbness on the heel and under the foot are possible consequences of the tarsal tunnel syndrome, as the tibial nerve in these regions has its sensitive, supplied by him areas. Similarly, the flexor muscles of the lower leg and the sole of the foot are supplied by the tibial nerve, so that the corresponding symptoms can occur here as well. Even if the symptoms are not very pronounced, those affected usually find these very stressful. Quick remedy is required because they are severely restricted in their movement and thus social life. They feel that they can no longer rely on their feet and become uncertain when walking. Many people complain of discomfort at rest, especially at night, and suffer as a result from lack of sleep.

As the disease progresses, permanent compression can cause irreversible damage to the nerve and possibly atrophy of the muscles supplied. The symptoms are permanently present in this case and there is a pronounced muscle weakness, which is accompanied by movement and stress restrictions.

causes

The causes of the tarsal tunnel syndrome include acute events in the ankle region, such as twists, severe bruising and fractures, as well as overloading. Other disorders of adjacent structures, such as the tendons, bones or joints (rheumatic diseases) or veins, may also result in tightness in the canal causing the above-mentioned ailments. The same applies to misalignment of the feet, which lead to corresponding incorrect or overloading. Last but not least, circulatory and endocrine disorders, pregnancy and menopause are associated with the onset of symptoms.

In the presence of arthritis, inflammation can lead to swelling and increased pressure on the tarsal tunnel causing compression of the tibial nerve. (Image: stockdevil / fotolia.com)

diagnosis

On the basis of a detailed survey of the patients on the symptoms that occur, the tarsal tunnel syndrome can usually already be limited well. A subsequent physical examination with palpation of the foot, ankle and lower leg can confirm the suspicion. Mechanically, it is also useful to look at the whole length of the nerve and to examine for possible compression already before the tarsal tunnel. The stress distribution in the leg and, of course, especially in the foot at rest and exercise is also to be checked and treated if necessary.

By palpation and tapping the tarsal tunnel syndrome can usually be diagnosed relatively reliably. (Image: Microgen / fotolia.com)

By measuring the nerve conduction velocity, compressions of the nerves are usually well recognizable and an electromyography can provide information about a possible impairment of the muscles. As imaging techniques to study the nature of the tarsal tunnel classical X-ray examinations and magnetic resonance imaging are used. However, diagnosis is not just a matter of determining the tarsal tunnel syndrome and its extent, but also identifying the causes as accurately as possible in order to take them into account in subsequent therapy.

Treatment of tarsal tunnel syndrome

First, as part of the treatment, it is important to avoid further errors or overloads, depending on the particular trigger. For example, insoles in the shoes can correct misalignments while reducing the burden of walking. In addition, an additional attempt is made to use cortisone to combat inflammation and to achieve a swelling of tissue structures in the tarsal tunnel in order to release pressure from the nerve. However, if, for example, a bone spur causes compression, it can not be remedied with medication and surgery remains the last option.

If no relief of the symptoms is achieved with the conventional treatment, in principle an operation may be considered in which a release of the retaining band retinaculum musculi flexorum and a removal of space-demanding tissue structures, a discharge of the nerve is to be achieved. However, postoperative healing may take several months, and not all patients experience complete symptom resolution. Here, the degree of nerve damage before surgery also plays an important role in the success of the treatment.

Not infrequently, an operation remains the only promising treatment option in tarsal tunnel syndrome. (Image: edwardolive / fotolia.com)

When sufferers feel that they can return to their feet through a successful treatment and use them without restriction, this is a great relief and brings them back to a state where they can fully enjoy their social activities. With appropriate complaints medical help should be taken promptly. Even if successful treatment sometimes takes a few months, there is a good chance of a life free from complications. (tf, fp, last updated 31.10.2016)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)