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Tarsal Tunnel Syndrome |
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Patient Testimonial 01/21/09 "I had a severe foot and leg injury in 2006. I had been in pain ever since. There was not a handful of days in over 2 1/2 years that I didnt cry everyday. I tried surgeries to my leg and foot, shots, physical therapy with little relief. I saw Dr. Still, he diagnosed the problem, operated and my pain is 90% gone and getting better. I'm finally getting my life back. This was the best surgery ever and I'm glad I did it". Shelly S. (Shelly had tarsal tunnle syndrome and a rare sural nerve entrapmet to her ankle, at the time of her testimonail she was 3 months post-surgery).-------------------------------Patient Testimonial 01/07/2009: "The surgery was much less painful than I expected and I am so glad I had it done! It's only been 6 weeks , but I can tell foot is healing great! Can't wait to get other foot done. Thanks Dr. Still!" Patricia E. (Patrica had a 25 yeer history of pain, at the time of her testimonial she was 6 weeks post surgery)
This condition of 'tarsal tunnel syndrome' affects the foot and ankle and can be very painful. Although the name is similar to the more common condition called “carpal tunnel syndrome” in the hand and wrist, tarsal tunnel syndrome is more difficult to diagnose and treat. This is due to the fact that other conditions of the foot and ankle can cause similar symptoms and the anatomy in the tarsal tunnel is complex. Dr. Still has advanced training in the diagnosis and treatment of tarsal tunnel syndrome at The Dellon Institute for peripheral nerve surgery directed by well known plastic surgeon and author, A.L. Dellon in Baltimore, Maryland. Common foot problems such as heel pain syndrome (plantar fasciitis) and intermetatarsal neuroma (Morton’s Neuroma) can cause similar symptoms. Unfortunately, one of the most common reasons for failure of treatment and surgery for plantar fasciitis and intermetatarsal neuroma is when a tarsal tunnel syndrome is the cause of the pain and has not been properly diagnosed. A high percentage of chronic plantar fasciitis may actually be due to nerve entrapment of one or more nerves in the tarsal tunnel.
The tarsal tunnel is the area on the inside of the ankle between the inner ball of the ankle (medial malleolus) and the Achilles tendon. The area extends down the inner heel and arch of the foot. The tunnel gets its name because anatomically there is a natural tunnel that many structures pass through. The “floor of the tunnel” comprises the bones of the inner ankle. The “roof” is made up of a thin but strong ligament like structure called the flexor retinaculum at the ankle and the thick and strong fascia of the abductor hallucis muscle. This muscle can be felt as the bulge on the inside of the foot just past the fat pad of the heel. For some people this muscle is quite prominent. This muscle fascia has a superficial and deep portion and often causes pinching (entrapment) of important nerves as they enter the arch of the foot and run their course along the sole of the foot. Within the tunnel lie the following tendons; posterior tibial, flexor digitorum longus and flexor hallucis longus. Also within this tunnel lie the posterior tibial artery and veins (2) and tibial nerve and its branches. The tibial nerve is a very important and large nerve that supplies the feeling and function (innervation) to the sole of the foot. The tibial nerve has three important branches that can branch off anywhere along the length of the tunnel. These are the calcaneal, medial plantar and lateral plantar nerves. When any of these nerves are pinched (entrapped) due to tightness in the tarsal tunnel pain, numbness, burning and other symptoms can result. When the calcaneal nerve is entrapped it can mimic the pain involved with heel pain syndrome or plantar fasciitis. When the lateral plantar nerve is pinched it can mimic the pain involved with a intermetatarsal neuroma. Most often, tarsal tunnel syndrome causes a deep aching pain on the inside of the ankle and heel and/or arch. The pain may radiate toward the toes or above the ankle. It may also cause numbness, burning, shooting pains to the foot and ankle. It usually does not affect muscle function. However, when severe, the pain can be quite debilitating for the patient.
This is why it is so important for the doctor to properly diagnose the cause of the pain so that treatment can be effective. Dr. Still has specialized equipment to test for nerve entrapment syndromes in the office. This is not painful and is done by using the Pressure Specified Sensory Device invented by Dr. Dellon. It is different than the more commonly used nerve conduction velocity testing performed by neurologists. The pressure specified sensory device is believed to be more accurate than nerve conduction velocity testing. Dr. Still is very experienced in treating tarsal tunnel syndrome. When symptoms are severe enough it requires surgery. The surgery is delicate and requires a surgeon trained to do so properly so that the entrapped nerve(s) are isolated and freed up of the structures that are binding or pinching them. The nerves are not cut or removed at all. The surgeon often uses special surgical loupes (magnifying surgical lenses) to perform the surgery. Dr. Still always attempts non-surgical treatment options before discussing surgery for tarsal tunnel syndrome. This may involve foot arch supports (orthotics) to help control the mechanics of the foot better, injections of medications or oral medications. Patients may also get relief with modalities such as acupuncture or massage therapy.
The causes of tarsal tunnel are numerous. Most often it is due to improper mechanics of the foot and ankle and lower leg causing repetitive strain on the tendons, ligaments and foot muscles in the area. Dr. Still beleives it is more common in people with standing occupations on hard surfaces. Other causes can be due to trauma such as fracture, tendon rupture, blunt injury, tumor or cyst formation in the tunnel. Prior surgery on the inside of the ankle or foot can cause this to occur in rare cases. For mild cases non-surgical treatments mentioned above are usually effective. Dr. Still recommends acupuncture in mild cases. In more severe cases surgery is necessary and has a high success rate. If you are a smoker or use tobacco, stop now it is making your tarsal tunnel syndrome worse! With surgery, the key is for patients to understand that the recovery for this surgery can be long because compressed nerves take several months to recover from being abnormally compressed. Patients are allowed to walk as pain tolerates from day 1 after surgery but usually are not back into shoes for at least a month. This is a nerve comporession syndrome and it involves the feet, which bear a lot of weight every day! It is completely unrealistic for patients to expect to recover from this surgery in a month, it takes time! Visit www.aens.us to learn more about the training in nerve surgery Dr. Still has received and nerve entrapment problems.
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