Tarsal Tunnel Syndrome is characterized by an entrapment of the posterior tibial nerve in the foot. It is a common cause of heel pain and is often misdiagnosed as plantar fasciitis. Tarsal tunnel syndrome is often tough to diagnose because the posterior tibial nerve trifurcates, or splits into three branches when it reaches the ankle, and because the cause of tarsal tunnel syndrome is truly unknown. Many theories exist, but little proof is available. Each patient must be carefully evaluated to determine their individual cause.
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Tarsal Tunnel Syndrome Symptoms
Symptoms of Tarsal Tunnel Syndrome include:
- Pain or tingling in the foot and toes
- Numbness
- Swelling, burning or redness in the heel
- “Electric shock” sensations in the leg
- Foot pain while driving or walking
While it is possible for all three nerve branches to become entrapped, most commonly only one branch, the first branch of the lateral plantar nerve or Baxter’s nerve, is involved. Baxter’s nerve has no sensory innervation and therefore entrapment has no numbness. Instead, there is a diffuse medial plantar heel pain and weakness in the foot muscles.
Non-Surgical Treatment
Non-surgical treatment of Baxter’s Syndrome and Tarsal tunnel syndrome is limited. Sometimes pain medication is prescribed along with orthotics to alleviate pain and correct flat feet. Although corrective orthotics can reduce pain in the feet, it will not fully resolve the issue. In my experience, an ultrasound guided cortisone injection around Baxter’s nerve has a high (>85%) cure rate.
When non-surgical treatment fails, surgery is recommended. Many patients report that they are very pleased with the results of the minimally invasive operation. The procedure can be completed at an outpatient surgical center.
What Happens Before Tarsal Tunnel Release?
The surgical center will provide you with individualized advice in the days and weeks leading up to your operation. On the day of your surgery, the anesthesiologist will give you a regional anesthesia known as a Popliteal nerve block. You will be placed on your stomach and injected with Novocain-like medication around the nerve in your leg. This gives complete pain relief that lasts for 12 to 36 hours. Patients report extraordinary satisfaction with this type of anesthesia. You will be given sedatives during the surgery. Some people require general anesthesia. All patients receive antibiotics just before surgery to help prevent infection.
What Happens During Tarsal Tunnel Release?
The operation begins with making a small incision on the side of your heel. The doctor will then identify the entrapped nerves and release them. The wound is closed with stitches. In some cases a temporary drain is placed.
What Happens After Tarsal Tunnel Release?
Pain relief from nerve release is almost immediate. Once the nerve block resolves, patients notice symptom improvement immediately. Wound healing takes two weeks, which means activities are limited until stitches are removed. Nerves take many months to completely regenerate and full symptom resolution and return of strength may take 18 months.
Patients who undergo an operation to repair Tarsal Tunnel Syndrome are typically placed in a weight bearing walking boot and given crutches for balance during the first few days to weeks after surgery. Your post-operative course may vary if other procedures are performed simultaneously.
Tarsal Tunnel Release General Recovery Timeline
This timeline is a general guideline. Your post-operative course may vary.
| Elevation | 23 hours / day for 3 days; swelling may last over 4 months. |
| Motion | Move your toes when the block resolves. This will decrease pain and swelling and improve healing. Begin ankle motion at 2 weeks. |
| Walking | Begin full weight bearing as tolerated in the removable fracture brace. |
| Bathing | Keep cast dry. Use a Dry Pro for the first two weeks. There are no restrictions after the cast is removed. |
| Pain Control | Expect to use strong narcotics for the first 2-5 days. Wean off as soon as you are comfortable using Tylenol or Motrin. |
| Work | Return depends on specific demands. It is safe to return to sedentary work at 10 days post-op. Return to heavy labor will take at least 4 weeks. |
| Driving | Patients with left foot surgery may drive an automatic transmission. Patients with right foot surgery may drive with the left foot only if they feel safe. |
Routine Clinic Visits
| 2 weeks | Stitch removal. |
| 2-4 weeks | Begin to wean from brace and start physical therapy. |
| 3+ and 6 months | Return for recheck. Strength improves over the next year. Minimal feelings of discomfort may linger, but your overall comfort level improves over a year. |
| ********** | If at any time during your post-operative period you notice any drainage or foul odor from your incision, a temperature of more than 100.4 degrees and/or increased swelling or tenderness, you should contact our office. |
For more helpful tips, check out these rehab exercise videos that will help you recover, or reach out to Dr. Silverman for more information!