Neurological Disorders: Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome is a type of neurological disorder and results from the compression of tibial nerve within the tarsal tunnel area of the foot. This is an example for entrapment neuropathy meaning the nerve gets compressed or entrapped and this results in damage to the nerve and manifests with various symptoms.

This condition is similar to the very familiar condition of the upper limb called as CTS ( carpal tunnel syndrome). Both are the result of compression or pinching of the nerve within a tunnel like structure (example for entrapment neuropathy).

This tunnel is formed in the medial (inner) aspect of the foot by the foot bones and a ligament structure (flexor retinaculum). The tibial nerve passes through it and gives of branches like medial & lateral plantar nerves and supply mostly the bottom of the foot.

Anything compromises the space in the tunnel can trigger this condition. This could be any structural problems arising within or out side the canal. Examples include tumors, cysts, granulomas, lipomas, bony overgrowth etc

Patient will characteristically present with the foot symptoms that are mainly confined to the bottom of the foot.

• Tingling (pins & needles)
• Numb feeling
• Difficulty with walking
• Thinning of the foot muscles (especially at the bottom)
• Weakness of the foot etc.

There are symptomatic as well as definitive treatments. Symptomatic treatments focus on the control of the symptoms like nerve pain, numbness, tingling sensation (pins and needle sensation) etc and meds like Gabapentin, Pregabalin, Amitriptyline etc are used in this regard. If the symptoms do not come under control with the above meds and if the symptoms are severe then the definitive treatments like surgical decompression of the entrapped nerve is tried and this may give permanent relief of the symptoms.

A neurologist is frequently involved in the management of this condition and if surgery is needed then a neurosurgeon is involved too.