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Foot Disorders | Tarsal Tunnel Syndrome
Pressure on these nerves can come from either swelling within the tunnel, such as occurs after a broken or badly sprained ankle, or from swelling within the nerve, such as occurs in association with medical problems like diabetes. Sometimes there may be arthritis of the ankle joint, a cyst or ganglion associated with the toe tendons or the ankle joint that causes the pressure upon the nerve. There are times when it is just not clear what has caused the problem.
When the nerves in these tunnels receive increased pressure, their blood flow decreases. When this happens, the nerve responds with altered sensations such as tingling and numbness. Sometimes this is so severe that it feels as if the whole foot is asleep. Often the symptoms are worse after standing or walking, when the fluid begins to collect in the foot. The small muscles may give you a cramping feeling as they begin to lose their nerve supply. If just the calcaneal (heel) branch is affected, the symptoms may seem such the same as a heel spur or plantar fasciitis, an inflammation along the bottom of the foot.
Any medical condition that you have that is known to affect the nerves must be given the best possible care. This includes disorders such as rheumatoid arthritis, lupus, alcoholism, thyroid gland dysfunction, and diabetes. Both heart and kidney conditions can cause your legs to swell and contribute to tarsal tunnel syndrome symptoms. It will be necessary to be sure that you do not have any back problems, such as lumbar disc disease that may be the cause of your foot symptoms. Often, tarsal tunnel syndrome and these other medical conditions or injuries are both present at the same time.
There is a place for a trial of anti-inflammatory medication if overuse or tendonitis is suspected. However, since no tendons actually pass through the tarsal or plantar tunnels, injecting steroids is not done frequently. Still, in selected cases, and with care not to inject the nerves themselves or the adjacent blood vessels, a cortisone injection may be tried. If the overwhelming sensory symptom is pain in the foot, and you have diabetes, a trial of medication useful for treating “neuropathic pain” is indicated. Such medications include Elavil, Dilantin, Neurontin and Tegretol.
The posterior tibial nerve is identified above the ankle, separated from its accompanying artery and vein and followed into the tarsal tunnel. Here the varying patterns for the origin of the calcaneal branches are observed and the calcaneal nerve or nerves are decompressed. The posterior tibial nerve sometimes has split into the plantar nerves before it enters the tarsal tunnel, in which case the nerves occupy more space than usual in the tunnel and make it more likely for the tarsal tunnel syndrome to occur. The branching pattern of the plantar nerves is observed and followed into the bottom of the foot, releasing the medial and lateral plantar tunnels just past the tarsal tunnel.
Any cysts or arthritic problems with the ankle joint may be corrected
at this time. If there is scarring within the posterior tibial nerve
or its branches, this is relieved by the technique of internal neurolysis.
During internal neurolysis, the outer layer of the nerve wrapping is
opened and the scar tissue is removed from within the nerve. In those
patients with symptoms of neuropathy due to multiple sites of nerve compression
along multiple peripheral nerves, such as can occur with diabetes, other
nerves in the foot may be decompressed at the same time as the posterior
tibial nerve and its branches.
If you have persistent swelling in your foot, you may be asked to wear support stockings or panty hose. If your foot remains swollen, it will be necessary to resume your activities more slowly.
• This information should be reviewed and any information not understood brought up and discussed with Dr. Ferragamo. It is hoped that this information may make you better aware of the operation, its potential benefits, risks and complications, and help you in the recovery period following surgery.
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|Tracy Ferragamo, D.P.M • 2925 Spafford St., Ste. A, Davis, CA 95618 • 530-753-9080|
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