Fist off- yes, I am still here! Unfortunately due to some pressing work projects, I had to take a break from posting to my website and social media. I’m back now, and I promise to post more frequently.
As the title says, the foot can experience the exact same type of condition the hand experiences during carpal tunnel syndrome. In the wrist, a ligament (firm connective tissue) binds together nerve, blood vessel, and tendon tissue that crosses underneath this tunnel-like region on the way to the hand. Caused by a number of issues, including chronic wrist strain and repetitive motions such as chipping away on a keyboard, the resulting symptoms can include pain, numbness, burning, or tingling in the wrist and hand, amongst other possible symptoms. Carpal tunnel syndrome is well known as it is very common, and very annoying. The EXACT SAME condition can occur in the foot.
In the foot, the condition is called tarsal tunnel syndrome (carpal refers to hand, tarsal to foot). The same symptoms can be felt in the bottom of the foot and heel, and the cause is generally the same. A ligament is present on the inner side of the ankle, and binds down a group of blood vessels and tendons under the inner side of the ankle bone. The tibial nerve is present in this area also running through a space that can be considered like a tunnel, and can be irritated. The nerve irritation can come from tightness in the overlying ligament, fibrous adhesions within the tarsal tunnel, varicose vein braces in the vein that runs next to the nerve, or masses/cysts in the space near the nerve. This irritation will eventually damage the nerve, and abnormal sensations will develop in the part of the foot the nerve gives sensation to, namely the majority of the bottom of the foot and heel.
Most of the time, the cause is repetitive strain to the inner ankle, either from a foot structure that rolls outward (flat or flattening feet) and tightens the ligament, tight shoes with abnormal pressure to the inner ankle, or trauma to this region that raises the pressure in the tarsal tunnel. Varicose vein braces, masses and cysts, as well as multiple less common causes can lead to tarsal tunnel syndrome as well.
If not treated in a timely manner, the symptoms can worsen, and be more difficult to treat and reverse. Initial treatment usually revolves around stabilizing the inner ankle to reduce mechanical strain the tissue, as well as measures to actively reduce inflammation within the tarsal tunnel. Diagnostic studies during treatment may include x-rays to look for bone abnormality, a nerve conduction velocity test that looks for delayed nerve transmission time across the tarsal tunnel, or an MRI to look for masses.
Surgical release of the tarsal tunnel, just like surgery for carpal tunnel syndrome, is very successful and nearly always leads to instant symptom resolution when conservative measure have failed.
Tarsal tunnel syndrome can be misdiagnosed by those not well trained in foot and ankle conditions, as sometimes the symptoms mimic other common conditions like plantar fasciitis or a neuroma in the ball of the foot. It is important that this be treated by a foot specialist experienced in treating the tarsal tunnel.
Scott R. Kilberg DPM 