Tarsal Tunnel Release Surgery for Tarsal Tunnel Syndrome
Persistent burning, tingling, numbness or shooting pain along the inside of the ankle and bottom of the foot may be caused by compression of the posterior tibial nerve. We carefully evaluate the foot, nerve and lower back before determining whether nonsurgical treatment or tarsal tunnel release surgery is appropriate.
What Is Tarsal Tunnel Syndrome?
The tarsal tunnel is a narrow space along the inside of the ankle. The posterior tibial nerve and its branches pass through this area before continuing into the foot. Pressure on the nerve can cause pain, burning, tingling, numbness or weakness.
Symptoms Along the Nerve
Symptoms may extend from the inside of the ankle into the heel, arch, sole or toes. The exact distribution provides important information about which nerve or nerve branch may be involved.
Foot Shape and Alignment
Flatfoot, hindfoot alignment and the way the foot bears weight may increase tension or pressure around the tarsal tunnel. We evaluate the structure of the entire foot rather than looking only at the painful area.
More Than One Possible Cause
Similar symptoms may arise from lumbar nerve irritation, peripheral neuropathy or compression elsewhere along the nerve. Identifying the actual source of the symptoms is essential before considering surgery.
A Careful Diagnostic Evaluation
Tarsal tunnel syndrome should not be diagnosed from foot pain alone. Our evaluation follows the tibial nerve from the lower back and leg into the ankle and foot to determine where the problem is most likely occurring.
- Examination of the anatomy, alignment and arch structure of the foot
- Mapping of burning, numbness and pain along specific nerve distributions
- Assessment for weakness or atrophy of the small muscles of the foot
- Evaluation for tenderness or nerve irritation at the tarsal tunnel
- Screening for lower-back conditions that can produce similar symptoms
- Review for swelling, previous injury, a mass or another source of compression
Will I Need an EMG?
We commonly obtain an EMG and nerve-conduction study when tarsal tunnel syndrome is suspected. The study can help evaluate nerve function, determine the possible location and severity of nerve injury, and look for evidence that the symptoms may originate in the lower back or another portion of the nerve.
An EMG is one part of the evaluation. Its findings must be interpreted together with the physical examination, symptom distribution and imaging when appropriate.
Nonsurgical Treatment Before Tarsal Tunnel Release
Surgery is not automatically the first treatment. Unless there is advanced weakness, significant muscle atrophy or a clear structural cause requiring intervention, treatment will often begin with conservative management.
Orthotics and Foot Support
Shoe inserts or custom orthotics may improve foot alignment and reduce mechanical stress around the posterior tibial nerve.
Physical Therapy
Therapy may address mobility, strength, gait, nerve irritation and contributing problems involving the foot, ankle or lower back.
Medication and Activity Changes
Anti-inflammatory treatment, temporary activity modification and other measures may help reduce irritation around the nerve.
Cortisone Injection
A carefully placed cortisone injection may decrease inflammation around the tarsal tunnel. The response can sometimes provide useful diagnostic information in addition to symptom relief.
When Is Tarsal Tunnel Release Surgery Considered?
Tarsal tunnel release may be considered when the examination and diagnostic studies support focal nerve compression and significant symptoms continue despite appropriate nonsurgical treatment.
Surgery may also be discussed sooner when there is progressive weakness, visible foot-muscle atrophy, severe nerve dysfunction or a clearly identifiable structure compressing the nerve.
Because burning and numbness in the foot can come from several different sources, careful diagnosis and patient selection are among the most important parts of achieving a successful surgical result.
Looking for a Tarsal Tunnel Surgery Evaluation?
Atlanta Bone and Joint Specialists evaluates foot alignment, nerve function, EMG findings and possible lower-back causes before recommending tarsal tunnel release or continued nonsurgical care.