What is Tarsal Tunnel Syndrome?
Tarsal Tunnel Syndrome is a condition caused by compression of the posterior tibial nerve as it passes through the tarsal tunnel, located near the inner ankle. In sports like basketball, this syndrome can develop due to repetitive stress, improper footwear, or biomechanical imbalances that cause irritation or inflammation. Symptoms may include burning, tingling, or numbness in the foot and ankle. In this article, we explain how to identify tarsal tunnel syndrome, how it differs from similar foot injuries, and what treatment options can help relieve the pressure and restore full movement.
Definition
The syndrome tarsal tunnel occurs when the nerves and blood vessels that pass through the tarsal tunnel located on the inner part of the ankle, is compressed or irritated. The compression can be due to multiple factors, including an inflammation of the tissues, an injury to the bones or the muscles surrounding the tunnel, or the presence of a cyst.
Causes
Tunnel syndrome ouede be caused by different factors, such as, for example, trauma, direct in the area of the tunnel, such as an ankle fracture or a ligament injury. It can also be caused by a mechanical compression in the area, such as the use of inappropriate footwear, or an increase in pronation of the foot. Pronation is the natural movement of the foot when walking or running, but in some cases, excessive pronation can cause a compression of the tarsal tunnel.
Diagnosis
The diagnosis of the syndrome tarsal tunnel starts with a physical evaluation and review of the medical history of the patient. The physical therapist can perform a series of tests to determine the presence of nerve compression in the area, such as Tinel’s sign, which consists in hitting the posterior tibial nerve in the tarsal tunnel to assess the patient’s feeling. You can also perform imaging tests, like an x-ray or an mri, to rule out other lesions and confirm the diagnosis.
Treatment
The treatment of the syndrome of the tarsal tunnel can be conservative or surgical. In mild to moderate cases, you may perform a conservative treatment that includes physical therapy, and changes in the lifestyle of the patient. The main goal of conservative treatment is to reduce inflammation and compression in the area of the tarsal tunnel.
Physical therapy may include techniques such as application of ice, massage, stretching, muscle strengthening and correction of the excessive pronation of the foot. You can also use orthopedic devices, such as templates or specialized footwear, to reduce the pressure on the affected area.
In more severe cases, or when the conservative treatment is not effective, it may be necessary to resort to surgery. The surgery consists in the release of the tarsal tunnel, to relieve the pressure on the nerves and vessels sanguneos. After the surgery, the patient will need a period of rehabilitation to regain the strength and mobility of the foot.
Rehabilitation
After the surgery, the patient will need a period of rehabilitation to regain the strength and mobility of the foot. The rehabilitation will include strengthening exercises, and stretching, as well as the application of techniques to reduce the inflammation and pain. The physical therapist may also use orthopedic devices, such as templates, to help to correct the over-pronation of the foot and reduce the pressure in the area of the tarsal tunnel.
Back to the action
The return to action will depend on the degree of recovery of the patient and the physical activity you want to perform. In some cases, it may be necessary to wait several months before returning to intense physical activity. The physical therapist will work with the patient to develop a rehabilitation plan custom and make sure that the patient is ready to return to physical activity in a safe manner.
Note: this article is only intended to be informational use. In any case self-diagnose. If you suffer from any medical condition, we recommend that you go to your physical therapy clinic of confidence.
Cedric Arregui Guivarch
National Coach of Basketball (CES 2014)
Bibliography and Webgrafía
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- Hidalgo-Lozano A, Fernández-Carnero J, Martínez-Strain CB, Stew-Barrilao R, Gómez-Arnau JI, Pecos-Martin D. Effectiveness of manual therapy in the syndrome tarsal tunnel: a systematic review. Physiotherapy. 2016;38(6):321-329.
- Rodríguez-Mansilla J, González-Sánchez B, Torres-Piles S. Effectiveness of electrical stimulation in the syndrome tarsal tunnel: a systematic review. Physiotherapy. 2017;39(2):92-100.
- Pascual Huerta J. The syndrome of the tarsal tunnel. Spanish journal of podiatry. 2017;28(2):74-86.
