Tarsal tunnel syndrome – also known as nerve compression syndrome or bottleneck syndrome – refers to damage to the shin nerve. It runs through the foot and causes painful discomfort due to damage or irritation.
What is Tarsal Tunnel Syndrome?
The doctor describes tarsal tunnel syndrome as damage to the tibial nerve ( nervus tibialis ). The localization is mainly in the ankle. In that area, the tibial nerve runs through the tarsal tunnel. The tunnel is formed by a tight band that runs through the inner malleolus of the foot. The shin nerve is responsible for controlling the muscles of the sole of the foot, while the lower leg muscles (which serve to bend the leg, for example) are also dependent on the tibial nerve. For what is pulmonary edema, please visit gradinmath.com.
Subsequently, all perceptions that are present in the lower leg area are passed on via the central nervous system. If there is constant pressure on the nerve in the tarsal tunnel, tarsal tunnel syndrome develops. The lower leg and foot are primarily affected.
In around 80 percent of all cases, a cause is found that is responsible for the tarsal tunnel syndrome. Above all, these are benign bone outgrowths (which subsequently narrow the so-called tarsal tunnel) or injuries. In a few cases, tumors are responsible; Inflammation in the region of the tarsal tunnel can also trigger the syndrome.
The tarsal tunnel syndrome is favored by foot-straining sports, a flat foot or ankle injuries and arthrosis. Diabetes mellitus or varicose veins are among the contributing factors. Tight, too high or rigid shoes, such as ski or mountain or hiking boots, can sometimes also be a trigger or significantly exacerbate the syndrome.
Symptoms, Ailments & Signs
The tarsal tunnel syndrome is mainly noticeable through abnormal sensations that occur during the night hours. Affected people complain about a numbness, a constant tingling or a burning sensation, whereby mainly the foot region is indicated. Sometimes those symptoms can also radiate (calves); the area of the inner ankle is permanently sensitive to pain. Symptoms can be aggravated by standing or walking for long periods of time. However, if the foot is elevated, the pain disappears.
The symptoms appear at irregular intervals at the beginning. Only as the disease progresses do the persistent phases increase; the nerve continues to be damaged, so the pain is permanent. The affected person then feels a significant muscle weakness, so that the foot movement can no longer be carried out correctly.
Diagnosis & course of disease
If tarsal tunnel syndrome is suspected, a doctor must be consulted immediately. Only with timely treatment is it possible that further nerve damage can be prevented. The attending doctor, ideally an orthopedic surgeon, will ask the patient various questions, which form part of the anamnesis. For example, since when the person concerned has been suffering from the symptoms and when they take on a particular intensity.
The doctor then examines the foot. Only by “tapping” the inner malleolus is it possible for the person concerned to report pain. If there is muscle weakness, this can already be the first sign of local inflammation. Swelling and warmth are sometimes indications that it could be tarsal tunnel syndrome.
The doctor checks the muscles using ENG – electroneurography. Through that examination, the speed and momentum of the nerve are checked. The diagnosis of tarsal tunnel syndrome can be confirmed by an X-ray. In many cases, an MRI – magnetic resonance tomography – can also provide information as to whether the so-called syndrome is involved.
If tarsal tunnel syndrome is treated too late or not at all, the symptoms worsen. The nerve suffers irreversible damage. For this reason, it is important that treatment takes place as early as possible. If permanent damage has already occurred, which mainly affects the tibial nerve, even an operation can no longer alleviate the symptoms.
First and foremost, those affected by tarsal tunnel syndrome suffer from various abnormal sensations and sensory disturbances. These have a very negative effect on the quality of life and can lead to restrictions in movement and in everyday life in general. Numbness can also set in and those affected often suffer from tingling or burning in the respective region.
The pain can also radiate into the calves. The symptoms often occur not only when walking, but also when standing or sitting. At night, the symptoms of tarsal tunnel syndrome can lead to insomnia and thus irritability in those affected. If left untreated, tarsal tunnel syndrome leads to muscle weakness, making normal movements of the foot difficult to perform.
If the nerve is irreversibly damaged, no further treatment is usually possible. The treatment itself is carried out with the help of cortisone and can limit the symptoms. In the case of a tumor, it must be surgically removed. As a rule, patients are dependent on therapies even after successful treatment.
When should you go to the doctor?
If there are irregularities in the shin or lower leg area, the processes should be monitored further. If the organism is overloaded once, the symptoms will be relieved after a period of rest or rest. If a lasting freedom from symptoms is achieved after a restful night’s sleep, in most cases there is no need for a medical check-up visit. In the future, physical activities should be geared to the needs of the organism.
If symptoms or irregularities persist over a longer period of time or if they increase in scope and intensity, a doctor should be consulted. A tingling sensation on the skin or a burning sensation indicate a health condition that needs further investigation and treatment. Pain, hypersensitivity to touch stimuli or a decrease in physical performance must be examined and treated. If the person concerned complains about irregularities in the inner ankle and foot, this is considered a sign of an existing disease.
Disorders of the general movement sequences as well as a general feeling of illness should be discussed with a doctor. If the pain increases when moving, the cause needs to be determined. If, due to the impairment, everyday obligations or usual sporting activities can no longer be performed, a medical examination should be initiated.
Treatment & Therapy
The physician must ensure that the so-called mechanical pressure on the nerve is reduced. With shoe inserts, it is possible for the load that the foot has to carry to be “transferred” to the outside, so that the inner foot perceives a relief. Medications are used to combat and alleviate the symptoms, but do not treat the cause.
Inflammatory processes are mainly treated with cortisone ; the surrounding tissues that are swollen can go down with the administration of cortisone. The nerve can be relieved by the decongestion. Conservative treatment is applied for around two months. If there is no significant improvement in the situation afterwards, the doctor must inform the person concerned that the tarsal tunnel syndrome can also be treated surgically.
During the operation, the tight ligament surrounding the tarsal tunnel is removed. In a few cases, parts of the nerve sheath also have to be split. Tumors or bone outgrowths must also be surgically removed. After the operation, it is important that the patient relieves the foot using crutches.
The success of the operation also depends on the concomitant diseases that led to the tarsal tunnel syndrome. Rehabilitation lasts six months; in some cases, another operation is necessary.
Tarsal tunnel syndrome cannot be prevented if it is caused by injuries or tumors or bone growths. Good shoes are important (no long-term wearing of high or stiff shoes) and the treatment of diseases that can promote tarsal tunnel syndrome.
If the tendinosis calcarea has to be treated surgically, subsequent aftercare is extremely important. After the surgical procedure, the affected shoulder should be rested for about three weeks. To treat the pain, the patient is given medication that has an analgesic and anti-inflammatory effect.
An important part of the aftercare of a calcified shoulder is the subsequent physiotherapeutic exercises. They take place after the acute pain subsides. After the tendon has healed, a pain-adapted mobilization treatment is carried out. If passive exercises are carried out in the first phase of therapy, active exercises are carried out in the second phase, which are useful for achieving full freedom of movement of the shoulder joint.
Pain-adapted therapy is understood to mean exercises that only load the shoulder as much as the pain allows. The pain threshold must not be exceeded. The postoperative follow-up treatment also includes a third phase. Within this framework, the stability, strength and muscle coordination of the affected shoulder can be completely restored.
Normally, the pain after a calcified shoulder operation has subsided noticeably after 24 to 48 hours. Therefore, the further follow-up treatment, which is carried out on an outpatient basis, can usually be carried out without any difficulties. The general state of health and any previous illnesses of the patient are also important. In about 90 percent of patients, long-term satisfaction can be achieved through follow-up care.
You can do that yourself
Patients with tarsal tunnel syndrome suffer from sometimes severe pain in the area of the diseased foot. The associated limitations in the mobility of those affected often lead to a temporary reduction in quality of life.
In order to reduce these symptoms conservatively and through self-help measures, patients with tarsal tunnel syndrome first discuss the available options with their orthopaedist. Those affected usually receive special insoles for their shoes, which are intended to provide relief. Patients treat the severe pain with drugs prescribed or recommended by the doctor. In order to support the healing process, people suffering from tarsal tunnel syndrome temporarily refrain from sporting activities. They also try to reduce the physical stress they may be exposed to at work.
If conservative measures do not bring about an improvement, surgery is usually the method of choice. Particular physical protection applies before and after this operation. After the procedure, the patients stop working for a few days and use the walking aids to relieve the operated foot. Together with their orthopaedist, those affected discuss measures to effectively prevent a recurrence of tarsal tunnel syndrome. This includes, among other things, the adaptation of the usual sporting activities.