Think back to the last time you got your blood pressure taken– remember that tight band that kept getting tighter and tighter and squeezed your arm? In Tarsal Tunnel Syndrome, the tingling and burning sensations felt in the feet come from a situation similar to this blood pressure example. The tarsal tunnel is a narrow gap in the foot where a tight bundle of nerves and tendons passes through. When an injury or inflammation occurs around the tunnel, it forces the tunnel to constrict (much like the band does when measuring your blood pressure). And just like your arm being squeezed with the band, when the Tarsal tunnel constricts, the tibial nerve can become squeezed. The tibial nerve carries feeling to your foot. So when it becomes pinched, the foot begins to tingle or go numb, leaving you with the familiar symptoms of Tarsal Tunnel.
Does Tarsal Tunnel sound familiar? Probably because you’ve heard of its better known cousin, carpal tunnel. Tarsal Tunnel is like Carpal Tunnel in your feet. The Carpal Tunnel is where the median nerve passes through your wrist and this nerve provides your hand with feeling. Similarly, when the Carpal Tunnel becomes compressed, numbness and tingling sets in, only this time in the hands.
Typical symptoms for tarsal tunnel include the characteristic numbness, tingling, or burning sensations in the feet. Tarsal Tunnel Syndrome requires a diagnosis from an expertly trained professional to check the severity and determine the best course of treatment. At Physician Partners of America, our physicians can help diagnose your condition, and if not Tarsal Tunnel, their experience and training can pinpoint whatever may be responsible for your pain.
When is surgery recommended?
Surgery is often recommended after all other nonsurgical methods have been tried with no success. Tarsal Tunnel is more easily reversed when treated early; cases caught early can often be solved with rest, immobilization to reduce swelling, NSAIDs and even injections to reduce swelling. But when those options have been exhausted, you and your doctor can discuss your surgical options which may include Tarsal Tunnel Release. For severe cases, where muscles have weakened and movement is difficult, surgery may be necessary to prevent any further damage to the nerve.
What is Tarsal Tunnel Release surgery?
To better understand the approach during surgery, first think about what you would do if something was too tight. What do we do with clothes that have suddenly (or maybe not so suddenly) become too snug? One option is to take them to a tailor and have them “let the garment out”. When surgery is the final option, the tunnel has remained compressed despite nonsurgical efforts to decompress the area. And so, the approach in surgery is to tailor the area around the tunnel to allow more space for the ligaments, nerves, and tendons to all fit well. No more squished tunnel, no more pinched nerve, and ultimately, no more pain and tingling.
In the surgery, the goal is to relieve the pressure on the nerve. To do so, the surgeons cut through the surrounding tissues that are adding the pressure, namely the lacinate ligament and tarsal muscles. Before beginning the surgery, the surgeon will apply a compression band above the ankle to control bleeding. Then, the surgeon will make an incision in the back of the ankle down to the arches where the compressed tibial nerve is located. They locate the laciniate ligament and make a cut to relieve pressure on the nerve. Finally, the incision is closed with sutures and the surgeon bandages the area. The procedure usually lasts between 30 minutes to a full hour.
What is it like after the surgery?
After your surgery is completed, you will be taken to our post-operative recovery room to relax. Our friendly staff will monitor you and make sure you are comfortable until you are released to go home. A long-lasting anesthetic may be used to manage postop pain, which means you may still experience numbness right after your procedure. But this sensation should be from the surgery, not because your nerve is still compressed. About 2-3 days following surgery, your bandage may be removed. It is important to keep your foot elevated and to move your toes to keep the swelling down. Walking is allowed, with as much weight as you feel comfortable bearing. Some patients opt for a cane or crutch to help control how much pressure they need to apply.
The recovery time for the surgery is about 2 months to get back to being 110%. During that time, your doctor or physical therapist may discuss exercises to help build your range-of-motion and flexibility. The prognosis for most patients is usually excellent and most can expect a full recovery, depending on the state of the nerve at the time of treatment. Treatments that
begin early have the best chance of both resolving symptoms and protecting the tibial nerve. Prolonged pinching of the tibial nerve can lead to long-term damage and life-long pain.
What are the risks?
Safety is one of our core values at Physician Partners of America, but as with any surgery, there are always risks involved when choosing surgery. For Tarsal Tunnel Release, patients are at risk for wound infection and continued pain and numbness in the foot. However, choosing to have your surgery done at our outpatient facility will reduce your risk of infection, since infection risk is higher at hospitals. Following surgery, if you notice any pain around your surgical wound, swelling or redness, or bleeding or other signs of infection, call you doctor. Similarly, if you have any symptoms of fever, dizziness, or achy muscles, call your doctor.