Tarsal Tunnel Syndrome - Everything You Need To Know - Dr. Nabil Ebraheim
ฝัง
- เผยแพร่เมื่อ 15 พ.ย. 2017
- Dr. Ebraheim’s educational animated video describes tarsal tunnel syndrome - medial ankle.
The tarsal tunnel is a fibro-osseous tunnel posterior and inferior to the medial malleolus. The tunnel is covered by the flexor retinaculum, which protects the structures contained within the tunnel. The flexor retinaculum is a thick ligament that runs between the medial malleolus and the calcaneus.
The structures which pass through the tunnel include the Tibialis posterior, the flexor Digitorum longus, posterior tibial artery, the tibial Nerve, and the flexor Hallucis longus. We are interested in the tibial nerve which lies between the posterior tibial artery and the flexor Hallucis longus.
Tarsal tunnel syndrome is a compression neuropathy caused by compression of the posterior tibial nerve within the tarsal tunnel. Tarsal tunnel syndrome is the most common compression neuropathy in the ankle and foot. Thickening of the flexor retinaculum may cause compression of the posterior tibial nerve.
Causes
80% of the cases are associated with a specific cause.
•Space-occupying lesion as lipoma or ganglia
•Varicose veins
•Muscle anomalies
•History of trauma
•Tenosynovitis
•Rheumatoid arthritis
•Diabetes
•Malaligned foot.
Symptoms of tarsal tunnel syndrome include burning pain, numbness, tingling, electric shock sensation typically around ankle or at the bottom of the foot (plantar aspect of the foot). Symptoms are worse with activity such as walking, standing or running. Tarsal tunnel symptoms are relieved with rest and elevation. Pain associated with tarsal tunnel syndrome may be worse at night. There may be swelling around the ankle and the foot.
Patient will have a positive compression test and a positive tinel’s sign. Tapping on the nerve posterior to the medial malleolus causes radiating pain into the medial side of the ankle and possibly to the foot.
Pressure within the tarsal tunnel increases with ankle dorsiflexion and foot eversion. This may reproduce the symptoms. Pain associated with tarsal tunnel syndrome radiates proximally and distally.
Tarsal tunnel may present as part of the heel pain triad which occurs in adults. The heel pain triad includes tarsal tunnel syndrome, plantar fasciitis and acquired flat foot deformity.
Diagnosis is by combination of history, examination, EMG and nerve studies that can lead you to the diagnosis (history is the most useful examination, EMG is accurate in about 80-90%). The dorsiflexion-eversion test is described to be helpful in the diagnosis of tarsal tunnel. Sensory nerve conduction studies are more helpful than motor studies (EMG). Always rule out radiculopathy.
Radiographs and CT scan may show osseous impingement or posteromedial process fracture of the talus. MRI may show a space occupying lesion such as a ganglion cyst or lipoma.
Differential diagnosis includes Peripheral neuropathy that involves all the nerves, not just the tibial nerve. Sural nerve and saphenous nerve are also involved and there will be an absent ankle jerk.
Treatment is immobilization, anti-inflammatory medications, and steroid injections. Patient may have orthotic with medial posting if the patient has a valgus hindfoot.
Surgical release of the tarsal tunnel if non-operative treatments fails after a trail of 3-6 months.
•Release the fascia proximal to the flexor retinaculum.
•Release the flexor retinaculum.
•Identify the tibial nerve proximal to the tunnel and decompress the nerve and its three branches.
•Decompress the entire tunnel 5 cm proximal to the flexor retinaculum and distally to the deep fascia of the abductor hallucis.
•Distal release of the Baxter’s nerve is usually done if the patient has chronic plantar medial heel pain (heel pain is uncommon in tarsal tunnel).
•Decompress the Baxter’s nerve by release of the deep fascia of the abductor hallucis.
•Remove any space occupying mass.
Best results occur if symptoms occurred in less than one year. A successful outcome occurs in about 50-90% of the cases. The best result occurs if the patient has space occupying lesion with a positive physical examination and EMG findings. The suboptimal results can occur from inadequate release traction neuritis and repeat tarsal tunnel release. In these situations, the patient will not respond well to surgery (always rule out double crush syndrome).
Revision surgery has a less successful outcome unless the patient has an inadequate release.
Recurrence of tarsal tunnel syndrome is usually caused by inadequate release and repeat tarsal tunnel release is usually not advisable. In general, tarsal tunnel decompression may not produce a good long-term outcome.
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![Inside of the Ankle Pain [Tarsal Tunnel Syndrome Treatment & Symptoms]](/img/n.gif)
Fantastic educational video!
I have also found conservative treatment consisting of cross fibre friction massage to the retinacular (being careful not to friction directly over the nerve), localised fascial stretching, followed by cryotherapy to reduce any post treatment inflammation. Strengthening exercises for the medial longitudinal arch may also help where pes-planus is involved.
Thank you for this clear and informative educational video, listened with interest.
TARSAL TUNNEL SYNDROME, SHOWING CLEARLY, THANKS FOR PROVIDING INFORMATION AND EDUCATES THE STUDENTS.
Awesome video. Thanks again
I am a US Coast Guard Veteran fighting for compensation on my feet. I have L5-S1 Surgery and have heel spurs, service connected fracture of Right foot, Right Ankle reconstruction, and now, it would seem: Left Foot Tarsal Tunnel. Why am I fighting so hard to make doctors understand my foot pain?
This video is super helpful. I want you for my doctor!
Donna Elks find a good doc... Also some feet problems are hereditary as i found out can be passed on
Donna Elks I’ve had the same trouble in reaching a point where it seems like my doctor understands clearly what is happening with me. I think if we were in sync the appointments would have a whole different feel to them. I might not be doing the best job explaining but that’s why I’m watching these videos to be able to be a better advocate for my health. Best wishes to you and thank you for your work
You are not alone
Thank you very much for the valid & descriptive information. It gave me proper idea of causes & remedy for my ailment.
Thank you for this informative video! I have had 2 episodes of extreme pain
in the frontal area of where my foot meets the leg.
a very informative video..thank you
You are the best as usual 👍👍👍
I have mild occasional tingling in the foot. I hike a lot. I did strengthen the peronius and felt some discomfort in the retinaculum. The thickened muscle is probably the reason. Thanks for excellent explanation!
Thank you, dr ebs!!! (From your former UTMC periop tech, Nina!)
I'm a Nurse and injured my foot in the military that led to tarsal tunnel. I'm currently having an exacerbation but my coworkers don't understand why I can barely walk without pain. I'm working a lot of overtime because of the pandemic. Great video. I hate trying to explain to people 😒
Get well soon.
Do exercise
Please take care of your feet I let mine go and kept working … had surgery on both feet and because I went so long before I got diagnosed correctly I have permanent nerve damage …
Don’t worry about explaining your pain. Everyone act they are doctors.
@@KoalaBeer. mine never went numb .. I had tarsal tunnel syndrome mine was nothing but 24/7 pain due to the nerves being crushed in both feet/ ankle I always wished they had went numb but people tell me that’s not good either :/
@@KoalaBeer. I will always have nerve damage but thank God Cymbalta helps me now.. it controls all of that nerve damage pain
Great As Usual
Thank you
Good, thanks
من اهم القنوات واكثرها فائدة من ناحية نشر الوعي الصحي... بس يا ليت ترجمة ... بعض المصطلحات غير واضحة💔
I had broke my left foot very good. My X-ray showed a multiple break back in 2017 . I work as a janitor at my work and sometimes I feel pain when I’m standing on my feet including the broken left foot . I stand on my feet like 6 hours a day of 4 days of a week
Great video!
wondering if i have tarsal tunnel syndrome, fell broke tibia /fibula, had surgery plate/screws on fibula, 2 screws in tibia, 9 wks now, and wt bearing pain is worse, foot still swollen, ice doesnt help much. PT is 3xwk, hurt all night afterward last n. i saw description of this in records; displ trimalleol fx r low leg, subs for clos fx w routn heal. i wish a gr8 neurologist lived around here. where is dr ebraheim from?
happy new year, and good health ...
exellent
How to remove posterior pain plz tell I'm suffering more pain in this lockdown
5:54 so the same recommendation as in back pain that after 3 or more months of corticosteroid injections which may worsen the symptoms by creating fat deposits around the nerve, to then decompress the nerve by removing that deposit and creating structural changes exposing a lot of sensitive structures, possibly creating nerve injury cutting all that fascia.
17% of all nerve injury is due to surgeons.
Iatrogenic Nerve Injuries, 2008
For some peripheral nerves, the percentage is much higher.
Among the surgeries most prone to nerve injury is carpal tunnel release, which seems to be the analog of tarsal tunnel surgery. Ganglion cyst removal was another one, probably because nerves run through the vascular tumor. Lymph node biopsies.
Fair the speaker points out limited success rate of the tarsal decompression surgery, and goes into all detail.
❤❤❤❤ now I’m confused
Does this affect a broken foot
I have Also this problem
I was running down the stairs and I misstepped and bend my whole foot inwards, I heard alot of cracks and now my tarsals hurt and my big toe keepa locking like it is connected or something. Anybody know what to do?
Get to hospital, or if you a hardcore use on hand to stabilize your foot another hand try to pull your toe back to position
1:10 I might need a mnemonic for the mnemonic.
足首骨折後
4カ月前から
左足の灼熱感とピリピリ感で足をついて歩くのが辛く仕事もままならず手術も考えています。手術して治ったかたいますか？
So basically, I'm screwed and will just have to ignore the pain.
I cut out sugar and carbs and pain went away. Not sure if that was the cause, but it went away and I'm so greatful!
Can any one give me a vid about tarsal tunnel anatomy not about the fucking every where syndrome ?
12 years ago I had an accident and broke both ankles
a bone called Talus came out of my left ankle... I had from time to time electric shock to my calcaneus (they were the kind that made my whole leg shake)
But in the last two years they have get worse, every night that I go to bed the Sural nerve (I guess it's the Sural Nerve) because I don't know anything about ligaments and bones
every night that I go to bed those sharp, shooting pains which don't let me sleep, and sometimes I'm taking up to 15 capsules of ibuprofen
Hi Cori, Are you better?
I am ao sorry to hear what you wrote..
I hope you get better...
Bitte Deutsch sagen ich habe pobleme
Duy linh da xem
Queremos que hablen en español gracias
aprenda inglés
Por favor. Traducción en castellano. Gracias.
aprenda inglés
Kann jemand hier deutsch ?
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