Tarsal Tunnel Syndrome

This condition is similar to a carpal tunnel syndrome in the wrist area. In other words, it is a nerve compression. The posterior tibial nerve passes through the tarsal tunnel, which is a tunnel-like structure below the medial ankle. It can be compressed due to various reasons and cause pain on the inside of the ankle. Various conditions could bring this on such as abnormal foot motions, arthritis of the ankle, ankle tendonitis, or venous insufficiency with associated swelling (edema).

Ankle pain gets worse with walking and standing, and radiates into the toes. There is worsening of the pain with tapping below the medial ankle (called "Tinel sign"). Electromyography shows exactly where the blockage is located and this needs to be done before surgery would be contemplated. If nerve entrapment is proven by EMG studies, no time should be wasted to have a surgeon do a surgical release, so that the nerve does not get damaged permanently through nerve atrophy. This is called tarsal tunnel release.

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Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999. Chapter 5.

2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 270.

3. Wheeless' Textbook of Orthopaedics: http://www.wheelessonline.com/

4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 60, p.487.

Last Modified: Jan. 28, 2008