Tarsal tunnel syndrome

What is tarsal tunnel syndrome (TTTS)?

It appears when there is a compression of the tibial nerve, medial and lateral plantar nerve as it passes through the tunnels that run along the inside of the foot-ankle, under the flexor retinaculum and adductor hallux muscle.

The scientific literature describes tarsal tunnel syndrome (TTS) as an underdiagnosed syndrome. It is classified as a rare pathology due to the difficulty in its diagnosis, since there is no diagnostic test that confirms this pathology, although it is usually detected as a result of plantar fasciitis.

What are its causes?

Its causes are multiple. The scientific literature indicates that up to 40% of this syndrome is idiopathic in origin, i.e., its cause is unknown. It is essential to perform a good study to identify its cause and thus determine the most appropriate treatment for the patient.

However, the most frequent causes are:

  • Inflammatory processes.
  • Sprains or ankle fractures.
  • Muscle hypertrophy.
  • Bulky veins.
  • Metabolic or systemic diseases such as diabetes, rheumatoid arthritis, hyporthyroidism and hyperlipidemia.
  • Flat-valgus foot.

What are the symptoms?

Some of the following symptoms may be experienced:

  • Tingling in the ankle area.
  • Burning sensation in the toes and sole of the foot.
  • Retromalleolar pain that extends along the plantar surface to the toes and even up the calf.
  • Cramp in the internal face of the ankle.
  • Sensation of stepping on glass or embers.
  • Important limitation for this standing or walking in a prolonged way.
  • It never causes morning pain. This symptom is common in the diagnosis of plantar fasciitis.
See also  Dysphonia

In more advanced stages, pain may occur while at rest and may even lead to night cramps and numbness.

What is the treatment?

The treatment must respond to the cause of the syndrome. However, the most commonly used are:

  • Antineuritic drugs, antidepressants.
  • Vitamins for the nerve
  • Local infiltrations with corticoids in acute phases.
  • Physiotherapy sessions.
  • Invasive radiofrequency to modulate pain.
  • Correction of flat-valgus foot
  • Control of sugar, thyroid, rheumatic disease, etc.

The patient will undergo surgery when the entrapment is identified, as this will avoid irreversible nerve damage and delayed nerve decompression.

There are two surgical techniques:

  1. Open surgery: decompression is performed with 6-7 cm incisions, under general or epidural anesthesia, with ischemia and requires hospital admission.
  2. Ultrasound-guided surgery: with only two 1-2 millimeter incisions the tarsal tunnel is decompressed. It is performed under local anesthesia, without hospitalization and without ischemia, which allows it to be performed in patients with health problems.

What specialist treats it?

The podiatrist, traumatologist, neurosurgeon or plastic surgeon will be the specialists in charge of the diagnosis and treatment of the tarsal tunnel.