Tarsal Tunnel | Tibial Nerve Entrapment

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Tarsal Tunnel/Tibial Nerve Entrapment



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!




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.



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.



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. 


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:

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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.


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!


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.



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


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!

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