Two posts ago we discussed tarsal tunnel syndrome. As a reminder, tarsal tunnel is the same as carpel tunnel, except for that it occurs in the feet. A nerve that provides sensation to the sole of your foot becomes compressed and trapped, causing discomfort and numbness. Let’s discuss some of the options we have to treat this condition.
The treatment of choice is based on the cause of the pain. Often, excessive pronation stretches the nerve to the point of causing tarsal tunnel symptoms. In this case, controlling the pronation could potentially help. This is done with custom orthotics made from molds of your feet taken at your podiatrist’s office. The molds are then sent off to a lab that makes orthotics that are specifically made for your feet. Once your feet get used to the inserts, the symptoms often disappear.
Tarsal tunnel can be caused by tendonitis (an inflamed tendon). In a case of tendonitis, the extra fluid around the injured tendon may be compressing the nerve in the tunnel. In this situation, the classic RICE (Rest, Ice, Compression, and Elevation) treatment may relieve symptoms. This will allow the tendon to recover and repair. In more severe cases, a small amount of corticosteroid can be injected into the area to decrease the inflammation.
If all conservative measures fail or are not indicated for your foot, surgery can be beneficial. The surgical procedure involves releasing the thick band of tissue overlying the tarsal tunnel. This relieves some of the pressure that is being put on the nerve. Often in surgery, the surgeon discovers large varicose veins or some other benign space occupying lesion (ganglion cyst, lipoma etc) inside the tarsal tunnel that are small and hard to see on MRI or other medical imaging. In these instances, the offending object is removed and surgery is very rewarding for the patient.
As mentioned before, treatment will differ depending on the cause. Work with your doctor to decide which pathway of treatment is best for your situation.