The tarsal tunnel syndrome is a pathology affecting the foot and ankle that is little known to the public, unlike its hand counterpart, carpal tunnel syndrome. carpal tunnel syndrome.
In fact, tarsal tarsal tunnel syndrome is much less common, but some specialists claim that it is more common than is believed and that its symptoms are mistaken for those of other foot ailments. its symptoms are confused with other ailments of the foot and the nervous system of the lower limbs. and of the nervous system of the lower limbs.
For this reason, every day the number of physicians who call for a detailed review of the cases of patients with neurological problems in the foot and ankle to rule out this tarsal tunnel syndrome.
Clinically, tarsal tunnel tarsal tunnel syndrome manifests with pain on the inner side of the ankle, foot and sole, especially when walking or exercising, and improves with rest.
It may be accompanied by paresthesias, tingling and burning along the longitudinal arch and plantar area of the toes and forefoot.
We will explain what this ailment is and how to treat it.
What is tarsal tunnel syndrome?
The full medical name of this pathology is posterior tarsal tunnel syndrome and it consists of a compression of the posterior tibial nerve or some of its branches, such as the lateral plantar nerve and the medial plantar nerve.
The tarsal tunnel is an osteofibrous osteofibrous structure in the form of a canal. located on the inner aspect of the ankle. In its course, this canal passes under the abductor digitorum muscle.
Its ‘roof’ is formed by the “flexor retinaculum” ligament that runs from the internal malleolus to the calcaneal bone or heel.
This ligament (flexor retinaculum) is responsible for providing stability to the flexor tendons. It is through this ‘canal’ that the posterior tibial nerve and its branches pass.
When this structure becomes inflamed, it presses on these nerves, causing pain, numbness and loss of strength in the foot. The number of cases reported annually is very low compared to the similar syndrome affecting the hand.
Even a few cases of anterior tarsal tunnel syndrome anterior tarsal tunnel syndromein which the deep peroneal nerve is pressed as it passes under the extensor retinaculum at the top of the ankle.
What causes posterior tarsal tunnel syndrome?
Although several causes have been identified for posterior tarsal tunnel posterior tarsal tunnel syndromethe main ones correspond to traumatic events, excess stress or strain, or congenital or acquired defects in the biomechanical shape and function of the foot.
Among the traumatic events that can result in posterior tarsal tunnel syndrome include fractures of the calcaneal bone, fractures of the internal malleolus and sprains.
This type of injury causes inflammation and inflammation and thickening of the annular ligament, which presses on the tibial nervewhich presses on the tibial nerve within the narrow space of the tarsal tunnel.
The cases related to foot stress or strain correspond to people who make repetitive and strong movements at the ankle and foot level, such as jumping and running sports.
In these cases, internal hemorrhages and tissue inflammation may occur, which press on the tibial nerve.
In turn, foot defects such as flat feet or valgus foot flat foot or valgus footcan affect the tarsal tunnel by increasing pressure and stress on the tendons and flexor muscles of the toes.
To a lesser degree, this syndrome may appear after inflammatory processes of the tendons and veins of the foot and lower leg, caused by the presence of varicose veins or cysts.
Finally, some systemic systemic diseases can affect the nerves of the extremities of the limbs. and cause this syndrome. These include rheumatoid arthritis, diabetes and hyperthyroidism, among others.
What are the symptoms of tarsal tunnel syndrome?
The tarsal tunnel syndrome usually manifests with pain in the inner aspect of the ankle, foot and plantar area of the foot, accompanied by tingling sensationmuscle weakness, cramps or burning sensation.
Pain may increase after long walks or when playing sports, climbing stairs or lifting heavy objects. The diagnosis of tarsal tunnel syndrome is complicated because its symptoms may resemble those of other foot disorders.
However, tests such as the Tinel test and the manifestation of sensory disturbances in the ankle and foot can be very helpful in detecting this syndrome.
Currently, electromyography is used to electromyography is now used to determine if any branch of the nerve is compressed and not functioning properly. and is not functioning properly. This method is very valuable in accurately diagnosing posterior tarsal tunnel syndrome. posterior or anterior tarsal tunnel or anterior tarsal tunnel syndrome.
What are the treatments for tarsal tunnel syndrome?
The treatment of this pathology will depend on the cause detected by the physician, such as systemic diseases, defects in the shape and function of the foot, sports or work activity, etc.
The first step is to relieve the pressure and pain with the use of anti-inflammatory drugs and in some cases anticonvulsants.
Insoles to correct the position of the foot, special footwear and other resources to improve the footprint are also often prescribed. In cases of severe inflammation, injectable corticosteroids are usually prescribed.
Unlike other foot problems, corrective surgery is a last resort and is reserved for very severe cases such as nerve compression due to the presence of tumors or when it is urgently required to open the retinaculum to decompress the tibial nerve.
Article prepared by Clínica San Román
Published on 2-3-2020