From The Doctor’s Desk

Because the symptoms of tarsal tunnel syndrome (TTS) can be confused with other conditions, proper evaluation is essential so that a correct diagnosis can be made and appropriate treatment initiated. That’s why the place to start is with one of the accomplished and highly skilled specialists at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado. Without treatment, TTS can lead to nerve damage. If you develop nerve damage, it can be permanent and irreversible. You may have difficulty walking, exercising, or performing your daily activities. Delayed treatment often requires more aggressive interventions. That’s why you should see Advanced Orthopedics now.

OVERVIEW

Tarsal tunnel syndrome (TTS), otherwise known as tibial nerve dysfunction or posterior tibial nerve neuralgia, is a compressive neuropathy of the foot caused by entrapment of the tibial nerve as it passes through the tarsal tunnel. While nerve compression syndromes like carpal tunnel syndrome are common in the wrist, the same type of compression in the foot is less common. This makes tarsal tunnel syndrome somewhat rare and often underdiagnosed. Some facts include:

• Women are approximately 3 times more likely to develop it
• Peak age of onset is 40-60 years old
• More common in middle-aged women
• Contributing Factors for Female Predominance
• Women typically have smaller tarsal tunnels
• Hormonal influences (similar to carpal tunnel syndrome)
• Higher rates of inflammatory conditions
• More likely to have flat feet (pes planus)
• Higher prevalence of rheumatoid arthritis
• Occupational Factors
• Jobs requiring prolonged standing
• Professions with repetitive ankle movements
• Work that involves sustained plantar flexion
• Anatomical Considerations
• Higher rates of ankle instability
• Greater foot mobility/flexibility
• Prevalence and Risk Factors in Athletes:
• Most common in runners and athletes who do a lot of jumping or cutting movements
• More frequent in athletes with flat feet (pes planus) or high arches
• Can be triggered by overtraining, especially on hard surfaces
• Often seen alongside other conditions like plantar fasciitis or posterior tibial tendonitis

THE TARSAL TUNNEL

The tarsal tunnel – the source of tarsal tunnel syndrome – is a narrow space that lies on the inside of the ankle next to the ankle bones, known as the tarsal tunnel.  The tunnel is covered with a thick ligament (the flexor retinaculum) that protects and maintains the structures contained within the tunnel—arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome. Specifically, the tarsal tunnel is formed by:

• Ankle bones: The tunnel is bordered by the medial malleolus (the bony prominence on the inside of the ankle) and the calcaneus (heel bone).
• Ligaments: The flexor retinaculum is the key ligament that forms the roof of the tarsal tunnel, covering and protecting the structures within.

Within the tarsal tunnel, the posterior tibial nerve branches out into smaller nerves that innervate the foot, providing sensation and motor function. The tunnel protects these nerves and structures, but swelling, inflammation, or other issues can lead to conditions such as tarsal tunnel syndrome, resulting in pain, numbness, or weakness in the foot.

The tarsal tunnel itself has four separate compartments, not just one continuous tunnel as often assumed. Each compartment has its own unique risk factors for compression. The tibial nerve helps carry sensory and motor function messages from your brain to 21 different muscles in the lower part of the leg.

WHAT IS TARSAL TUNNEL SYNDROME?

Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space. While nerve compression syndromes like carpal tunnel syndrome are common in the wrist, the same type of compression in the foot is less common. This makes tarsal tunnel syndrome somewhat rare and often underdiagnosed. It is most common in runners and athletes who do a lot of jumping or cutting movements.

Read more about Tarsal Tunnel Syndrome on our new Colorado Springs Orthopedic News Site – Colorado Springs Orthopedic News. Schedule an appointment with an foot and ankle specialist today.