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TARSAL TUNNEL SYNDROME
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What is it?

The tarsal tunnel is a canal located between the Achilles tendon and the medial malleolus (bony bump on the inside of the ankle). Tendons, blood vessels and the tibial nerve travel through the tarsal tunnel. This nerve provides sensation to the bottom of the foot and helps with movement of the foot and ankle. When this nerve is compressed or irritated in the tarsal tunnel where it causes pain and/or dysfunction, it is called tarsal tunnel syndrome (TTS). Tarsal tunnel syndrome may be caused by an injury, disease or chronic repetitive stress.

 

Symptoms/Risks

Symptoms of TTS include pain radiating into the arch of the foot and heel. People with this condition may feel pins and needles or numbness in the sole of the foot and may have weakness in the muscles of the lower leg and foot. TTS symptoms typically increase with prolonged standing and walking. People might also notice foot swelling, and pain might persist at night. Individuals at risk for TTS are those with chronic medical conditions such as osteoarthritis, rheumatoid arthritis or diabetes. Individuals who overpronate, which is an abnormal foot movement where the foot rolls in when you walk or run, are also at risk for TTS.

 

Sports Medicine Evaluation & Treatment

A sports medicine physician will ask about symptoms and obtain a complete medical history. The physician may gently tap over your tibial nerve to see if this reproduces symptoms. Imaging with x-ray, ultrasound, or MRI may be useful to evaluate for cysts, arthritis or other bony abnormalities which could cause TTS. A nerve conduction study, which helps evaluate nerve function, may be done to confirm the diagnosis.

Treatment for TTS depends on the cause. Rest from aggravating activities, ice application and anti-inflammatory medications can be helpful immediately after an injury. The physician may recommend corrective footwear, braces, orthotics or taping to correct foot biomechanics and reduce pressure on the nerve. Stretching and strengthening exercises are often recommended to improve lower extremity function and balance. Foot and ankle swelling may be managed with massage or compression stockings. If conservative treatment fails, then a corticosteroid injection into the tarsal tunnel can be helpful. Surgery to release the tarsal tunnel may be indicated if other options have not improved the symptoms.

 

Injury Prevention

Managing underlying medical conditions such as rheumatoid arthritis and diabetes can reduce the risk of developing TTS. Wearing appropriate footwear and maintaining strength in the muscles of your legs, ankles and feet can help prevent lower extremity injuries. Gradually increasing participation in high-impact activities such as running can also be helpful. Early recognition of signs and symptoms of TTS is important.

 

Return to Play

Athletes can return to play once there has been a significant reduction of symptoms and the underlying causes are being corrected. Sport-specific strength, mobility and function should be restored as well.

AMSSM Member Authors
Nicole T. Yedlinsky, MD and Lisa Vopat, MD

References
Ahmad M, Tsang K, Mackenney PJ, Adedapo AO. Tarsal tunnel syndrome: A literature review. Foot Ankle Surg. 2012 Sep;18(3):149-52
Jackson DL, Haglund B. Tarsal tunnel syndrome in athletes. Am J Sports Med. 1991 Jan-Feb;19(1):61-5
Ferkel E, Davis WH, Ellington JK. Entrapment Neuropathies of the Foot and Ankle. Clin Sports Med. 2015 Oct;34(4):791-801
McSweeney SC, Cichero M. Tarsal tunnel syndrome-A narrative literature review. Foot. 2015 Dec;25(4):244-50

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