• Definition Tarsal Tunnel Syndrome: Tarsal tunnel syndrome is defined as injury, damage, or inflammation to the tibialis posterior nerve.
  • Causes of Tarsal Tunnel Syndrome: The most common causes of this condition is pulling or stretching of the nerve behind the ankle bone. Frequently excessively flat feet will put strain on the nerve that can eventually become damaged or irritated. Other causes include trauma to the tarsal canal, varicose veins in the canal, or tendon injury in the same canal.
  • Definition Flatfoot: The term flatfoot when used to describe foot pathology does not describe the height of the arch of a foot. The term is used synonymously with the words pronation or pes planus. It is intended to describe a genetically inherited instability of the rearfoot. The rearfoot has two bones, the heel bone (calcaneus) and the bone above it and below the ankle (talus). The rearfoot composes the foundation of the foot. During walking if it functions normally, it stabilizes all the bones in the foot and allows them to function normally.
  • Symptoms: Pain, numbness, tingling, electric shock, shooting sensation, are frequent reported symptoms with injury to the tibialis posterior nerve. Walking seems to frequently exacerbate the symptoms and rest can alleviate these symptoms.
  • Treatment #1: The first treatment appropriate for tarsal tunnel syndrome is immobilization and protection to prevent further stress to the nerve. Flatfoot is the most frequent cause an therefor should be controlled immediately. Orthotics are used to control and stabilize the rearfoot (calcaneus and talus). Orthotic casting involves placing the bones of the foot in a proper stabile alignment, and capturing this corrected shape in a cast. This cast is then sent to the lab. There a positive of the cast is made and then a proper orthotic is made over an exact replica of the corrected foot according to my prescription. Orthotics take up some room in shoes and that they will not fit in all shoes. The patient may need to purchase larger or different style shoes to accommodate orthotics. Cam Walker Boot is another immobilization device that can be used as a temporary measure.
  • Treatment #2: Injection of local anesthetic with cortisone can reduce inflammation and alleviate symptoms. A series of these injections are usually necessary. Injections should always be used only if rest and protection of the nerve has been addressed.
  • Treatment #3: In severe cases open surgical decompression may be needed. This procedure is a last chance approach to relieve symptoms and carries multiple risks that should be addressed carefully before deciding to proceed.
  • Printed version of this counseling was dispensed to the patient.

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