Tarsal Tunnel Syndrome

I realize there’s another thread about this, but it’s five years old, and the membership has shifted a lot since then, so I thought I’d go ahead and start a new one, instead of reviving a zombie.

This is the topic for medical questions, right? If I’m wrong, mods, please move.

Anyway, my left foot as diagnosed with the foot version of carpal tunnel syndrome last week. The doctor said it’s probably been in the works for a while, so the event which brought it to bloom, didn’t exactly cause it, just tipped the bucket. (Apologies for mixing my metaphors.)

So, the bottom of my foot is numb, to different depths, making walking really awkward. Until I learned how to walk on it, I was getting all sorts of cramps in my calf and shin-- very painful.

Movement in my toes, but limited. Normal movement in my ankle now, but that was limited for a while.

Right now, the doctor has me on some very strong anti-inflammatories, and I start PT next week. I’m supposed to elevate the foot as much as is practical, while going about a normal day.

If there’s no improvement in a month, I get steroid injections.

Anyone have stories to share? Recovery? non-recovery? What helped? what made it worse? Any healthcare workers with experience treating it who want to participate?

This is oddly rare, given the prevalence of carpal tunnel syndrome. There are only about 200,000 new cases of TTS in the US in a year.

FWIW, I’ve been checked for everything else it could be-- blood clots, MS, tumors. I’ve had a huge battery of tests in the last several weeks. No open sores, discoloration, not even at the nail beds. No visible swelling. And I actually have both a job and lifestyle that involve both lots of walking and lots of standing. So, I’m a candidate for it. I have a history of the kind of activity that could lead to it as well. I think the diagnosis is correct.

Tarsal tunnel syndrome is a compression neuropathy of the posterior tibial nerve, which runs in a tunnel (along with other structures), beneath a fibrous ligament (flexor retinaculum), behind the inner ankle bone (medial malleolus). Symptoms are similar to those of carpal tunnel syndrome, and include pain, numbness, and tingling distal to the entrapment. There may also be motor involvement.

Simple diagnostic tests include the dorsiflexion-eversion test and Tinel’s Test. A positive tinel’s sign is tingling on percussion (tapping) along the PT nerve, proximal to where it enters the foot. More definitive tests include MRI, EMG and nerve conduction study.

Conservative treatment should always be tried before surgery. Conservative treatments focus on reducing the inflammation and swelling of the PT nerve. RICE (rest, ice, compression, elevation), NSAIDs, corticosteroid injections, orthotics (to reduce tension on the nerve), and physical therapy modalities may all be tried, but success rates are low to middling.

Surgery involves decompressing the PT nerve, by cutting the flexor retinaculum. This can be done open, or endoscopically. Success rates are good (more so with idiopathic TTS, than post-traumatic TTS), so long as your surgeon doesn’t cut the nerve, or adjacent PT artery. I’ve done this operation dozens of times (open and closed) with very good outcomes. Proper post-op care is important.

If you require surgery, just make sure your surgeon is competent, has done TTS surgery before (preferably endoscopically)…and doesn’t drink in the OR. :slightly_smiling_face:

Good luck!

Moving to IMHO, where people can share opinions about medical stuff and offer advise.