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Tarsal tunnel syndrome (posterior tibial neuralgia)

foot assessment for Tarsal Tunnel Syndrome

Tarsal tunnel syndrome, also known as posterior tibial neuralgia, is a painful foot condition in which the posterior tibial nerve or one of its branches within the tarsal canal is impinged and compressed.

Patients who present with this condition typically complain of numbness in the foot, radiating to the toes, pain usually on the inside of the ankle, burning sensation on the bottom of the foot that radiates upwards, electrical sensations, pins and needles and increased sensation in the feet, swelling of the feet, hot and cold sensations in the feet, and tingling over the base of the foot and the heel and sometimes the toes.

The cause of this condition can be due to anything causing compression of the nerve in its compartment. These can include benign tumours, ganglion, lipoma, exostosis or cysts within the tarsal canal, bone spurs, inflammation of the tendon sheath, generalised leg oedema, metabolic disorders such as diabetes, post-traumatic ankle deformities, arthritis, rheumatoid arthritis, over-pronation (ankles rolling in) and varicose veins (enlarged blood vessels) can also cause compression of the nerve.

At Mint Foot Care Podiatry, we can this condition by taking a thorough history, performing a biomechanical assessment and video gait analysis. Diagnostic imaging such as X-rays, ultrasound and MRI may be necessary for diagnosis.

Based on the findings a combination of treatment options may be prescribed including:

  • Rest and Ice – keeping off the foot and reducing activity prevents further injury and encourages healing. Ice can reduce inflammation, swelling and symptoms.
  • Non-steroidal anti-inflammatory medication – help reduce the pain and inflammation such as ibuprofen or aspirin.
  • Supportive footwear.
  • Custom made orthotic therapy – orthotics may be prescribed to address any biomechanical factors such as over pronation.
  • Immobilization – restricting movement in a brace or cast is sometime necessary to reduce symptoms and reduce pressure on the tibial nerve.

Surgical treatment of tarsal tunnel syndrome is sometimes required when there is no response to conservative management.

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