In tarsal tunnel syndrome (tarsal congestion syndrome, nerve compression syndrome), the tibial nerve, which also runs through the foot, is irritated or damaged. The cause is a constriction of the so-called Tarsaltunnels, which is located near the ankle joint. This leads to pressure damage to the nerve. The result is sensations such as tingling and pain in the forefoot. Sometimes the tarsal tunnel needs surgery to relieve the nerve. Learn all about the symptoms, diagnosis and treatment of the tarsal tunnel syndrome.
Tarsal tunnel syndrome: description
Tarsal tunnel syndrome refers to damage to the tibial nerve (tibial nerve) in the area of the ankle. There the nerve passes the so-called Tarsaltunnel. The tunnel is formed by the inner knuckle of the foot and a tight band. The tibial nerve controls the muscles of the sole of the foot and the lower leg muscles, which are responsible for the flexion of the leg. Furthermore, all sensations in the area of the lower leg, the heel and the sole of the foot are directed via the nerve to the central nervous system. If the nerve in the tarsal tunnel is irritated by permanent pressure, it is called the tarsal tunnel syndrome. Feet and lower legs are mainly affected.
Tarsal tunnel syndrome: symptoms
The tarsal tunnel syndrome is mainly characterized by nocturnal discomfort in the area of the front sole and toes. Burning in the foot, numbness and tingling often torment the sufferer all night. The symptoms can also radiate into the calf. In addition, the area around the inner ankle is permanently sensitive to pain. Prolonged standing and walking intensify the symptoms, but elevating the foot and rest can relieve it.
Since the nerve initially regenerates again and again, the symptoms appear irregular at first. In the course of the disease, the nerve suffers permanent damage, the sensations and pain persist. Later, the nerve-supplied muscles can also be damaged. Those affected feel a muscle weakness and can not move the foot properly. A typical movement, which in this case is only possible to a limited extent, is the control of the accelerator pedal when driving a car.
Tarsal tunnel syndrome: causes and risk factors
In about 80 percent of cases, one cause for the tarsal tunnel syndrome can be found. Most are injuries or benign bony outgrowths that constrict the tarsal tunnel. Occasionally, however, even small tumors or inflammations can lead to a bottleneck in the structure.
Malformations of the foot such as a kinked foot, but also foot-straining sports and misalignment of the ankle due to injuries or arthritis promote the formation of a tarsal tunnel syndrome. Varicose veins or diabetes mellitus are also considered risk factors. Too tight or high, rigid shoes such as mountain boots or ski boots can trigger a tarsal tunnel syndrome or reinforce the syndrome.
Tarsal tunnel syndrome: examinations and diagnosis
If you suspect a tarsal tunnel syndrome you should consult a doctor early. This often helps to avoid permanent damage to the nerve. The doctor, an orthopedist, will ask questions such as:
- Since when do the symptoms exist?
- When are the symptoms particularly intense?
- Does the pain only occur during exercise or at rest?
- Can the symptoms be triggered or amplified in any way?
- Have you been hurting your foot lately?
- Are you suffering from a disease that affects the foot or its nerves?
After that, the doctor examines the foot. Sometimes he can provoke the pain by tapping the area under the medial malleolus. A weakness in the nerves supplied muscles, but also signs of local inflammation such as swelling and overheating may be evidence of a tarsal tunnel syndrome.
By a Electro-neurography (ENG) The nerve and the muscles supplied by it can be checked. In this study, the excitability of the nerve and the speed with which it passes an impulse are examined. The diagnosis of a Tarsaltunnelsyndroms can also by a X-ray photograph or one magnetic resonance imaging (MRT).
Tarsal tunnel syndrome: treatment
The most important thing first is to reduce the mechanical pressure on the nerve. Shoe inserts can cause the load to be directed from the inside of the foot to the outside. Medication is prescribed for the pain. Cortisone inhibits possible inflammatory processes and thus leads to faster swelling of the surrounding tissue. Even so, the nerve is relieved.
If, after about two months, there is no improvement in pain relief and discomfort therapy, usually only surgery can help to relieve the sufferer of pain and discomfort. Here, the Tarsaltunnel surrounding, tight band is removed. Occasionally, part of the nerve sheath must be split. Bony outgrowths or tumors are also surgically removed. After the operation, the foot must be relieved by means of support crutches.
Tarsal tunnel syndrome: disease course and prognosis
Without treatment, the symptoms of a tarsal tunnel syndrome become more and more severe. The nerve is eventually irreversibly damaged. The syndrome should therefore be treated as early as possible. If permanent damage to the tibial nerve has occurred or muscle functions have failed, surgery usually can not reverse this.
The success of an operation also depends largely on the comorbidities, for example, injuries, the length of the affected nerve segment and the regeneration capacity of the nerve. The rehabilitation process after surgery can take up to six months. In some cases, a reoperation is necessary to treat the discomfort of the patients tarsal tunnel syndrome to alleviate.