Treating Heel Pain: Tarsal Tunnel Syndrome

January 09, 2012 Posted by Dr.Chang

There are a number of other common contributors to heel pain due to the nerves that are tightly packed in around your Achilles tendon and the calcaneus bone. The posterior tibial nerve runs from the back of your lower leg, around the inside of your arch and to the bottom of your foot. When it is compressed by all the other muscles, tendons, ligaments and bones in your lower leg, ankle and foot, the compression can cause a burning sensation, numbness in the first three toes, tingling at the base of the foot and the heel, and a whole lot of pain that is both localized and even shoots up the leg. This condition is called tarsal tunnel syndrome (TTS), or posterior tibial neuralgia. TTS often causes more prolonged discomfort than plantar fasciitis after periods of rest. This could be because the posterior tibial nerve is connected to the sciatic nerve that runs along your legs, hip and lower back. Also unlike plantar fasciitis, which often has a general point of pain, TTS does not usually cause pinpoint tenderness along the plantar fascia.

Tarsal tunnel syndrome [KB1] can be caused by a number of factors. Basically, anything that causes compression in this area, be it cysts, bone spurs, inflammation, or even swelling from an ankle sprain, can aggravate the posterior tibial nerve. Biomechanics may play a role in TTS, as an abnormal gait may aggravate the posterior tibial nerve. Again, because of the numerous contributors to TTS, it is essential to contact your podiatrist for a diagnosis that will detect the underlying causation of TTS.

Tarsal tunnel syndrome (TTS) has a number of treatment methods. First, slow down with exercising and find an exercise that does not aggravate the pain or numbness in your foot (swimming is usually a good option, and even aqua jogging if you have a hard time restraining yourself from running). Your podiatrist will prescribe anti-inflammatory medications (NSAIDs, such as Ibuprofen, Advil or Motrin) to reduce the inflammation and alleviate your heel pain. Cortisoid injections might be helpful for some conditions. Key to treatment, however, will be making sure that your arch is supported, as rigid arch supports have been shown to help those with TTS. Over the counter and custom orthoticscan help relieve symptoms, and making sure your everyday and athletic footwear are the right size for you, supportive of your foot, and not too worn out will be key in tackling the problem long term. Working with a physical therapist will help you find stretches and massage techniques to lessen the compression causing your TTS.

If no other treatment strategies help, your podiatrist may suggest a surgery called “tarsal tunnel release.” This surgery will decrease pressure on the posterior tibial nerve by releasing the lacinate ligament, an exploration of the tarsal canal and decompression of the posterior tibial nerve. Note that surgery requires a recovery period of three to eighteen months depending on the procedure, so it is important that you work dedicatedly with your podiatrist on other treatment methods for some time before you and your doctor decide that surgery is the best option for you.


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