Tarsal Tunnel Syndrome
The tarsal tunnel is a fibro-osseous space located behind and below the medial malleolus. The structures present in the tarsal tunnel are the posterior tibial tendon, the long flexor tendon of the fingers, the posterior tibial artery and vein, the posterior tibial nerve, and the flexor hallucis longus. Tarsal tunnel syndrome is a neuropathy caused by compression of the posterior tibial nerve or one of its branches within the tarsal tunnel.
Aetiology
Tarsal tunnel syndrome can be caused by intrinsic factors, extrinsic factors or a combination of both. Intrinsic factors include: osteophytes, retinaculum hypertrophy, tendinopathy and space-occupying lesions such as ganglion cysts, lipomas and tumours. Extrinsic factors include: direct trauma, tight footwear, varus or valgus foot, generalised lower limb oedema (pregnancy, venous congestion), systemic inflammatory arthropathy, diabetes and post-surgical scars. The most common aetiologies may be classified as: space-occupying lesions, foot deformities and traumatic injuries.
Symptoms
The predominant symptom of tarsal tunnel syndrome is pain directly over the tarsal tunnel that radiates down the sole of the foot. Other common symptoms include burning and/or paraesthesia in the sole of the foot, which is exacerbated at night. Symptoms may be aggravated by activities such as standing or prolonged walking.
Treatment
Depending on the aetiology, treatment may be conservative or surgical. Conservative treatment may include rest, physiotherapy, change in activities, change of footwear, anti-inflammatory medication, painkillers or specific medication to control neuropathic pain. Physiotherapy is recommended and includes stretching and strengthening exercises for the extrinsic and intrinsic foot muscles, neural mobilisation exercises, bandaging, cryotherapy, joint manipulation, massage and ultrasound (electrotherapy). If conservative intervention does not relieve symptoms, surgery may be considered, or only viscosupplementation or Platelet-Rich Plasma in ultrasound-guided procedures.
If you need treatment for tarsal tunnel syndrome, contact our physiotherapy clinics in Lisbon.
