Tarsal tunnel is compression or entrapment of the Tibial nerve and its branches as they pass along the inside of your leg and ankle and makes its way into your foot.

There are multiple locations where this nerve must travel through tight tunnels made of fascia and ligaments. The problem is that there are many other things that need to travel with it and can often lead to greater issues. Typically, 3 tendons (tibialis posterior, Flexor digitorum longus and flexor hallucis longus) with the Tibial artery and 2 veins accompany the Tibial nerve as it courses through the tarsal tunnel or under the ligament called the Flexor retinaculum.

Lots of things can affect the nerve itself as well.  The nerve can get swollen from some diseases. If the nerve swells from diabetes, chemotherapy,  thyroid disorders or from a compression of the nerve more proximally (like “sciatica” or bulging disc) or if the veins swell from venous disease, or if trauma/scar tissue impinge this nerve then lack of blood flow or ischemia can occur in the nerve and pain and dysfunction normally follow close behind.

Nerve pain is often described as electrical or sharp shooting pain, numbness, hypersensitivity, burning or tingling that can be present all the time or after activity.

Patients often tell us that this pain does not go away and can even keep them awake at night. Those sensations are often described as “Neuropathy” and Nerve Entrapment can cause you to have neuropathy type pain due to the compression of the nerve.

If you have ever fallen asleep on your arm or hit your nerve in your elbow, then you have had a taste of what neuropathy from nerve entrapment can feel like. Heel pain that does not get better from the typical plantar fasciitis treatment protocol can be tibial nerve entrapment as the nerve travels through this area and supplies the sensation to the heel and bottom of the foot.

Neuropathy simply means “Nerve (Neuro) disease or suffering (pathy). It is more a description of symptoms than a specific diagnosis.

Certainly, nerve compression is one type of neuropathy.

It is actually a good one to have because it can usually be fixed!!!!

A thorough physical examination is essential to determine whether the tibial nerve is entrapped and in what section of the ankle.

We check if there is pain to pressure, changes in sensation along the tarsal tunnel and whether your nerve elicits shocks up and down your leg with tapping. These are all signs of nerve compression.

We examine the nerve with an ultrasound we have in office for any abnormalities or changes in the typical size.

Another great test is a diagnostic/therapeutic injection. Using a local anesthetic and corticosteroid that we place along the nerve under ultrasound guidance helps the nerve regain function. These injections can last from 6 hours to months but can give a picture of how the nerve would function if the entrapment sites were removed. They are diagnostic because they tell us whether or not your “pain generator” is where the injection was given.  If you get a positive response to the injection then it is a pretty safe bet the pain is coming from that part of the nerve.  These injections have to be done very accurately. That is why we use an ultrasound to image the nerve and make sure it is give in the right place. They are also  therapeutic because they can provide relief from the pain. 

Nerves that have been pinched for too long can have permanent damage and may not regain the same level of function as they originally had. Due to this fact, we do not like to delay too much  when specific signs and symptoms of nerve entrapment are present.

Nerve decompression surgery consists of following your nerve at its various entrapment sites and removing the tight bands that are causing its dysfunction. This is commonly referred to as a tarsal tunnel release but in fact a complete tibial nerve release is much more extensive that what is described as a tarsal tunnel release.

There are actually 4 tunnels and 4 nerves that need to be released for a successful outcome.

Since the peripheral nerves are vulnerable impaired blood flow, we will see improvement immediately while we perform the procedure. The small blood vessels for the nerve (Epineurial vein and arteries) will become more visible and the nerve swells from the increase in blood flow and removal of the constricting areas.

Surgery in the tarsal tunnel area typically heals within 2-3 weeks while the patient wears a protective boot.

Patients are recommended to keep the foot elevated on 4-5 pillows for 4-5 days immediately post op. This is to prevent bleeding and swelling around the nerve (which creates a lot of scar tissue which is no good after nerve surgery). After that, just take it easy and keep it up most of the time…like in a recliner.

You can walk immediately post op, but just limit it to bathroom trips the first 4-5 days. Although there is pain from the surgery patients often tell us that they notice the difference and the debilitating symptoms from the nerve entrapment have started to resolve.

There are risks involved as with any surgery and the most common tend to be slow healing of the incision and pain/numbness along the surgical incision, infections and failure of the surgery(1-5%).