Tarsal tunnel syndrome - pain and numbness in the feet
We walk an average of around 10,000 to 15,000 steps a day, with our full body weight resting on our feet. A guarantee for our movement is that the feet work well and painlessly. In so-called tarsal tunnel syndrome, disorders occur due to the compression of a nerve.
Tarsal tunnel syndrome describes nerve compression in the area of the tarsal tunnel, whereby the tibial nerve is surpassed. The tarsal tunnel is located on the inner ankle under a tether (called Retinaculum musculi flexorum). The tibial nerve (called the tibial nerve) runs in it - and therefore also under the ligament. This can be disconnected there, which leads to sensations, pain and functional impairments.
Symptoms of nerve compression
Sudden onset of pain and disturbances in sensitivity (paraesthesia) with sensitivity to touch, tingling and numbness on the heel and under the foot are possible consequences of tarsal tunnel syndrome, since the shin nerve in these regions has its sensitive areas it supplies. The flexor muscles of the lower leg and the sole of the foot are also supplied by the tibial nerve, so that the corresponding complaints can also occur here. Even if the symptoms are not particularly pronounced, those affected usually find them very stressful. Quick remedies are necessary because they are severely restricted in their movement and thus social life. They feel that they can no longer rely on their feet and become insecure when walking. Many complain of complaints, especially at night, during periods of rest and subsequently suffer from a lack of sleep.
As the disease progresses, permanent compression can lead to irreversible damage to the nerve and possibly atrophy of the muscles supplied. In this case, the symptoms are permanent and there is an eye-catching muscle weakness, which goes hand in hand with restrictions on movement and stress.
The causes of tarsal tunnel syndrome include acute events in the ankle region such as twisting, severe bruising and fractures, but also overloading. Other diseases of the neighboring structures, such as the tendons, bones or joints (rheumatic diseases) or veins, can also lead to narrowing in the canal, which causes the above-mentioned complaints. The same applies to misalignment of the feet, which lead to corresponding incorrect or overloading. Last but not least, circulatory and hormonal disorders, pregnancy and menopause are associated with the appearance of the symptoms.
The tarsal tunnel syndrome can usually be narrowed down well by means of a detailed survey of the patients about the symptoms that arise. A subsequent physical examination with palpation of the foot, ankle and lower leg can confirm the suspicion. From a mechanical point of view, it also makes sense to look at the entire path of the nerve and to examine it for any compression before the tarsal tunnel. The load distribution in the leg and of course especially in the foot during rest and movement should also be checked and treated if necessary.
By measuring the nerve conduction velocity, compressions of the nerves are usually clearly recognizable and electromyography can provide information about a possible impairment of the muscles. Classic X-ray examinations and magnetic resonance imaging are used as imaging methods for examining the nature of the tarsal tunnel. However, the diagnosis is not just about determining the tarsal tunnel syndrome and its extent, but also the causes should be determined as precisely as possible in order to take them into account in the subsequent therapy.
Treatment of tarsal tunnel syndrome
First of all, it is important to avoid further malfunctions or overloads in the course of treatment, this being seen depending on the respective trigger. For example, insoles in the shoes can correct misalignments and at the same time reduce the strain on walking. In addition, attempts are often made to use cortisone to combat inflammation and reduce the tissue structures in the tarsal tunnel in order to relieve the pressure on the nerve. However, if, for example, a bone spur is the cause of the compression, it cannot be remedied with medication and surgery remains the last option.
If the conventional treatment does not alleviate the symptoms, an operation can generally be considered in which a relief of the nerve is to be achieved by separating the Retinaculum musculi flexorum holding band and removing bulky tissue structures. However, healing after surgery can take several months and not all patients achieve a complete symptom resolution. The degree of nerve damage before the operation also plays an important role in the success of the treatment.
When sufferers feel that they can rely on their feet again and use them without restrictions through successful treatment, this is a great relief and leads them back to a state in which they can fully carry out their social activities. Medical help should therefore be sought promptly in the event of complaints. Even if a successful treatment sometimes takes a few months, there are good prospects for a largely symptom-free life afterwards. (tf, fp)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr. Fabian Peters, Barbara Schindewolf-Lensch
- University Clinic Hamburg-Eppendorf (UKE): Tarsal tunnel syndrome (accessed: August 13, 2019), uke.de
- Austria's public health portal: Tarsal tunnel syndrome (accessed: 13.08.2019), gesundheit.gv.at
- Ruchholtz, Steffen / Wirtz, Dieter Christian: Orthopedics and trauma surgery essentials: Intensive course for further training, Thieme, 3rd edition, 2019
- Tarsal tunnel syndrome (posterior tibial neuralgia) (accessed: August 13, 2019), msdmanuals.com
- Professional association for orthopedics and trauma surgery e. V .: Tarsal tunnel syndrome (accessed: August 13, 2019), orthinform.de
- National Organization for Rare Disorders (NORD): Tarsal Tunnel Syndrome (accessed: August 13, 2019), rarediseases.org
- American College of Foot and Ankle Surgeons (ACFAS): Tarsal Tunnel Syndrome (accessed: August 13, 2019), foothealthfacts.org
ICD codes for this disease: G57ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.