Our expert says:
Tarsal tunnel syndrome results from the entrapment of the tibial nerve. The tibial nerve follows a long, curving route down the back of the leg to the ankle, where it turns and curls below the inside of the ankle.
A common cause is trauma to the ankle, such as a fracture or sprained ankle. When the injury heals, fibrous tissue develops, similar to a scar. If too much scar tissue forms, it can restrict movement in the tarsal tunnel and cause entrapment of the nerve.
Simple techniques to relieve some of the symptoms are ice, anti-inflammatories, immobilization (such as with a cast walking boot) and cortisone injections. Anti-inflammatory medications may take up to seven to 10 days to become effective. A cortisone shot usually works within 24 hours. Alterations to your shoe wear, such as using orthotics, may take several weeks to have an effect.
If conservative treatment measures are unsuccessful, surgical treatment (Tarsal Tunnel Release) may be necessary. An incision is made behind and below the inside of the ankle and the surgeon cuts the laciniate ligament, providing room for expansion of the nerve.
Following surgery a removable boot is worn for approximately four weeks and physical therapy should be embarked on to decrease the swelling and scarring over the nerve.
Pain and symptoms generally begin to improve with surgery, but you may have tenderness in the area of the incision for several months after the procedure.
Your ankle will be supported in a plaster splint for 10 days after surgery. During this time, you may also be instructed to use crutches to keep from placing weight on your foot while you stand or walk.
Take time during the day to support your leg with the ankle and foot elevated above the level of your heart. You are encouraged to move your ankle and toes occasionally during the day. Keep the dressing on your foot until you return to the doctor. Avoid getting the stitches wet. Your stitches will be removed 10 days after surgery, at which time you will switch to a supportive walking boot.
Physical therapy sessions may be advised for up to eight weeks after surgery. Full recovery could take several months. You'll begin by doing active movements and range of motion exercises for the ankle and toes. Therapists also use ice packs, soft-tissue massage, and hands-on stretching to help with the range of motion. When the stitches are removed, you'll begin doing exercises to help strengthen the muscles that support the ankle and arch. Therapists also use special stretches to encourage the tibial nerve to slide inside the tarsal tunnel.
Some of the exercises you'll do are designed to get your leg and ankle working in ways that are similar to the activities you do every day, such as rising on your toes, walking, and going up and down stairs.
Your therapist will help you find ways to do your tasks that don't put too much stress on your ankle and foot. Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems.
These are however general guidelines and please consult a biokineticist or physiotherapist for an assessment and appropriate treatment plan for your individual situation.
The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal
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