Tarsal Tunnel | Tibial Nerve Entrapment

TARSAL TUNNEL | TIBIAL NERVE ENTRAPMENT Frequently Asked Questions

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%).

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TARSAL TUNNEl TIBIAL NERVE ENTRAPMENT

treatment
options

Nerves can be very temperamental. They have very high energy requirements. An abnormal stretch on the nerve, like a “stinger” commonly seen in football with the brachial plexus, can cause temporary damage or permanent depending on the injury.

When the following conservative treatments fail or the entrapment on the nerve is severe then we will consult with you on nerve decompression surgery.

Ask about our minimally invasive treatment for nerve pain!

CONSERVATIVE CARE
TREATMENTS OPTIONS

01

SUPPLEMENTS

Inadequate blood flow or lack of nutrients that are essential for nerve function often play an important role in nerve regeneration and function. We have found that providing the nerves with specific supplements may provide the ideal environment for the nerve to function with less pain and symptoms.

A few examples are:

  1. L-Arginine
  2. Alpha Lipoic Acid
  3. Benfotiamine

The amino acid L-Arginine can assist with crucial blood flow while Benfotiamine can provide an absorbable form of thiamine which tends to be deficient in diabetics and is essential for nerve function.

02

STRETCHES & PHYSICAL THERAPY

There are also stretches such as nerve gliding and physical therapy that can help with your nerve pain. These can be powerful and valuable tools once we have determined why you are having nerve pain.

03

DIET & EXERCISE

Diet, exercise, avoiding nicotine products, alcohol and medications that are known to cause neuropathy will also be part of the game plan to overcome your nerve pain. 

ADVANCED
TREATMENTS & SURGERIES

Dr. Silvester and Dr. Larsen specialize in many advanced minimally and non-invasive treatments, and if necessary, advanced minimally invasive and traditional surgical techniques with patient proven success stories.

Some of those are used to treat tarsal tunnel | tibial nerve entrapment, such as:

  • Electrical Signal Therapy (EST)
  • Nerve Decompression Surgery
  • Nerve Stimulator Implant

Learn More >

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%).

Chronic pain at the tibial nerve can also be addressed with direct electrical nerve stimulators via a nerve stimulator implant.

This may be an option for patients that do not improve with other treatment and is usually assessed with a trial stimulator procedure to evaluate if the stimulator relieves the pain.

If successful then patients can have a permanent implant placed and wear a small non-invasive device to provide the nerve with direct stimulation and relief.

How much more can your nerves take?

Nerves are very delicate. Nerves have enemies.

8% stretch causes 50% decrease in blood flow in a nerve. 15% stretch causes 100% decrease in blood flow and the nerve can never recover from that amount of stretch.

Compression of 50 mm HG decreases blood flow by 60% in the nerve. 60mm Hg pressure results in 80% decrease in blood flow.

Click the icon to request a appointment call back request, or call us at 210-375-3318.

Most surgery is better delayed until you “need it”.

Nerve decompression surgery is an exception.

 

Many studies have shown that the longer a nerve is compressed the worse the outcome of the decompression surgery. The sooner the pressure is off the nerve the better the nerve will.

choose us?

1. OUR CONTINUED EDUCATION

Our doctors have been doing nerve surgery on feet foot a long time. We stress and pride ourselves on continued education in nerve procedures in order to offer the most up-to date treatments options.

All of our doctors are members of the Association of Extremity Nerve Surgeons, performing hundreds of nerve surgeries per year on the lower extremities.

Simply put, we probably do more nerve decompression surgeries than anyone in South Texas!

2. OUR DIAGNOSTIC EQUIPMENT

We also have all the diagnostic equipment and skill to help sort out your nerve pain right here in our Universal City Clinic location.

Our Surgery facility is right next door.

NO HOSPITAL TRIP NEEDED.

ON-ON-ONE CONSEIRGE SURGERY EXPERIENCE.

Beyond that, we have access to outstanding equipment to shorten your recovery time and provide further nerve rehabilitation if you need it.

3. OUR DIAGNOSTIC EQUIPMENT

We are pioneers in peripheral nerve implantable stimulators for those patients who have pain that just won’t respond to traditional treatments.

So, if you or a loved one suffers from nerve or foot pain, please give us a call at 210-375-3318 and lets make your NEXT STEP’s great ones!

Take the next step
to happy feet!

Click the links to request your appointment or learn more about what Next Step Foot & Ankle Clinic can do for you.

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