Tarsal tunnel syndrome

Clemens Gödel is a freelancer for the medical team.

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In tarsal tunnel syndrome (tarsal bottleneck syndrome, nerve compression syndrome), the tibial nerve, which also runs through the foot, is irritated or damaged. The cause is a narrowing of the so-called tarsal tunnel, which is located near the ankle. This leads to pressure damage to the nerve. The result is abnormal sensations such as tingling and pain in the forefoot. Sometimes the tarsal tunnel needs to be operated on to relieve the nerve. Find out everything about symptoms, diagnosis and treatment of tarsal tunnel syndrome here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. G57

Tarsal tunnel syndrome: description

Tarsal tunnel syndrome is the term used to describe damage to the tibial nerve (tibial nerve) in the area of the ankle. There the nerve passes the so-called tarsal tunnel. The tunnel is formed by the inner ankle of the foot and a tight ligament. The shin nerve controls the muscles of the sole of the foot and the muscles of the lower leg, which are responsible for flexing the leg. Furthermore, all perceptions in the area of the lower leg, the heel and the sole of the foot are transmitted to the central nervous system via the nerve. If the nerve in the tarsal tunnel is irritated by constant pressure, it is called the tarsal tunnel syndrome. The foot and lower leg are mainly affected.

Tarsal tunnel syndrome: symptoms

The tarsal tunnel syndrome is mainly characterized by nocturnal abnormal sensations in the area of the front soles of the feet and the toes. Burning feet, numbness and tingling often torment those affected all night. Symptoms can also radiate to the calf. In addition, the area around the inner ankle is permanently sensitive to pain. Standing and walking for long periods of time exacerbate the symptoms, but elevating the foot and resting can alleviate them.

Since the nerve initially regenerates again and again, the symptoms appear irregularly at first. In the course of the disease, however, the nerve suffers permanent damage, the paresthesia and pain persist. Later on, the muscles supplied by the nerve can also be damaged. Those affected feel muscle weakness and can no longer move their feet properly. A typical movement, which in this case is only possible to a limited extent, is the control of the accelerator pedal when driving a car.

Tarsal tunnel syndrome: causes and risk factors

A cause of the tarsal tunnel syndrome can be found in around 80 percent of cases. Usually it is injuries or benign bone outgrowths that narrow the tarsal tunnel. Occasionally, however, even small tumors or inflammations can lead to a bottleneck in the structure.

Malformations of the foot such as arched arches, but also sports that put strain on the feet and malpositions of the ankle joint due to injuries or osteoarthritis promote the development of a tarsal tunnel syndrome. Varicose veins or diabetes mellitus are also considered risk factors. Shoes that are too tight or too high, such as mountain or ski boots, can trigger or worsen tarsal tunnel syndrome.

Tarsal tunnel syndrome: examinations and diagnosis

If you suspect a tarsal tunnel syndrome, you should consult a doctor early on. In this way, permanent damage to the nerves can often be avoided. The doctor, an orthopedic surgeon, will ask, among other things, the following questions:

How long have the symptoms existed?
When are the symptoms particularly intense?
Does the pain only occur during exertion or does it also occur at rest?
Can the symptoms be triggered or exacerbated in any way?
Have you injured your foot lately?
Do you have a disease that affects the foot or its nerves?

Then the doctor examines the foot. Sometimes he can provoke the pain by patting the area under the medial malleolus. A weakness in the muscles supplied by the nerves, but also signs of local inflammation such as swelling and overheating can be indications of a tarsal tunnel syndrome.

Electronurography (ENG) can be used to check the nerve and the muscles it supplies. During this examination, the excitability of the nerve and the speed with which it transmits an impulse are checked. The diagnosis of tarsal tunnel syndrome can also be supported by an X-ray or magnetic resonance imaging (MRI).

Tarsal tunnel syndrome: treatment

First of all, the most important thing is to reduce the mechanical pressure on the nerve. Shoe insoles can cause the load to move from the inside of the foot to the outside. Medication is prescribed for the pain. Cortisone inhibits possible inflammatory processes and in this way leads to faster swelling of the surrounding tissue. This also relieves the nerve.

If after about two months there is no improvement in the symptoms due to pain and relief therapy, usually only an operation can help to relieve those affected from pain and abnormal sensations. The taut ligament surrounding the tarsal tunnel is removed. Occasionally, part of the nerve sheath needs to be split. Bone growths or tumors are also surgically removed. After the operation, the foot must be relieved using crutches.

Tarsal tunnel syndrome: disease course and prognosis

Without treatment, the symptoms of tarsal tunnel syndrome get worse. The nerve is eventually irreversibly damaged. The syndrome should therefore be treated as early as possible. If permanent damage to the tibial nerve has already occurred or muscle functions have failed, an operation can usually no longer reverse this.

The success of an operation also depends largely on the accompanying illnesses, for example injuries, the length of the affected nerve section and the regenerative capacity of the nerve. The rehabilitation process after an operation can take up to six months. In some cases, another operation is necessary to relieve the symptoms of patients with tarsal tunnel syndrome.

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