Tarsal Tunnel Syndrome

What is it?

Tarsal tunnel syndrome is a condition in which one of the nerves that runs to the bottom of the foot is compressed, resulting in possible numbness, tingling or pain. The tarsal tunnel refers to an area of the foot that is formed between the medial malleolus (bone on the inside of the ankle) and the flexor retinaculum (a band of ligaments that stretches across the foot). Nerves, arteries and tendons all run through the tunnel and can be compressed.

Tarsal tunnel syndrome may result after an injury such as an ankle sprain in which swelling causes compression on the nerve. It may also develop with diseases such as diabetes or arthritis which can also cause swelling and compression. In addition, it can be the result of foot shape/position including having flat feet or fallen arches which then produces strain and/or compression on the tibial nerve.

What are the treatment options?

Tarsal tunnel syndrome can often be managed conservatively through injections, physical therapy, orthotics and stretching. Steroid injections are used to decrease pain. Physical therapy may be prescribed to help reduce swelling and pain in the compartment as well as for instruction in stretching exercises if needed. I night splint may be prescribed for patients with a valgus foot or a foot orthosis may be given to post the foot and decrease the load to the tarsal tunnel.

If conservative treatment fails, surgical intervention may be warranted to free the tibial nerve from any fascial covering. Surgery for tarsal tunnel syndrome is most successful in cases where there is a well-defined mass causing the compression and less predictable in other circumstances. Your physician will determine if this is an appropriate treatment option.

Procedure Goals

The aim of tarsal tunnel surgery is to free the compressed nerve, decrease pain and restore mobility.

Risks of the Procedure

There is increased risk of nerve or posterior artery injury that could have major effects on foot function.

Plantar fasciitis may develop post-operatively and cause persistent pain in the heel and may need to be addressed.

What to Expect

Before Procedure

The day of the procedure, you will need to arrange for a ride to and from the procedure and arrange for help at home.

Wear shorts or loose pants and a t-shirt for surgery.

Do not eat or drink anything after midnight for arrivals before noon. Otherwise, do not eat or drink anything seven hours prior to your arrival at the surgery center. If crutches or a walker are needed, please rent or borrow them prior to your surgery.

You will be contacted by Lawrence Surgery Center to set up your patient account. They will inform you of your pre-operative instructions as well as tell you when to arrive for surgery.

After Procedure

Your foot will be placed in a post-operative dressing and a splint. You will most likely be non-weight bearing for three weeks. After the splint is discontinued, you can begin gradual range or motion activities and return to weight bearing with possible use of a surgical shoe.

Discharge Instructions

Diet

You may resume your regular diet. However, start slow with clear liquids and gradually work your way back to your normal diet. This will help prevent nausea and vomiting.

Ankle Care & Bathing

If applicable, use crutches as directed.
Keep your ankle elevated above heart level as much as possible for the first five days, then as needed when symptomatic for up to two weeks. This will prevent painful swelling and promote healing.

Cold Therapy

To help reduce pain and swelling, apply an ice pack to the surgical area for 20 to 25 minutes every one to two hours for the first 48-96 hours and then as needed to help control pain and swelling.
To avoid frostbite, place a towel or t-shirt between the ice pack and your skin.
It is not necessary to use ice while sleeping.

Pain Medication

Your physician will give you a written prescription for pain medicine as you leave the surgery center. Take your pain medication as prescribed. You may want to take it regularly for the first 48 hours after surgery. Do not take any additional Tylenol.
While you are asleep in the operating room, a long acting numbing medication may be injected into the surgical area to help relieve your immediate postoperative discomfort for up to 24 hours. When you first notice tingling or throbbing, begin taking your pain medicine so it will become effective before the local anesthesia wears off.
No driving while taking any narcotic pain medication!
The pain medication may cause some nausea so take it with food.
The pain medication and general anesthesia may also cause constipation, so you may need to take a stool softener, fiber bar, Metamucil or prune juice to prevent constipation.

Follow-up Care

Watch for temperature > 101.5F, persistent numbness and tingling in the foot, persistent bleeding or drainage from the wound, foul odor, progressively worsening pain that is unresponsive to pain medication, blue toes, chest pain or difficulty breathing. If you have any of these symptoms, call the office if during normal business hours or go to the nearest emergency room.
If you do not have a postoperative appointment set-up already, please call the office to schedule an appointment for 7-10 days after surgery at (785)843-9125.

Rehabilitation Plan - Exercises

Physical therapy may be prescribed for conservative treatment in order to decrease pain and swelling as well as for instruction in stretching exercises for the calf. After surgery, therapy may be warranted to help decrease scar tissue formation as well as restore normal foot and ankle range of motion and mechanics.