WHAT IS TARSAL TUNNEL SYNDROME:

Tarsal tunnel syndrome (TTS) is a posterior tibial nerve compression neuropathy. Symptoms include pain spreading into the foot, which is generally exacerbated by walking. There is also weakness and atrophy of the small foot muscles, as well as loss of foot sensation.

CAUSES:

Tarsal Tunnel Syndrome is caused by any type of tibial nerve entrapment or compression. Idiopathic or posttraumatic causes are common in many patients. Other possible causes include:Activities that cause repetitive stress, such as jogging, prolonged walking, or standingInjuries such as fractures, dislocations, and stretchingVarus or valgus heelFibrosisExcessive WeightTarsal tunnel lesions that take up space, such as ganglions, tumors, edema, osteophytes, or varicositiesTendinitisSystemic disorders causing ankle inflammation or nerve damage (ex: diabetes mellitus, arthritis)arthrosis,Rheumatoid Arthritis.Gout.

SIGNS AND SYMPTOMS:

paraesthesia (burning, numbness, or tingling).Shooting pain in the foot's sole.The pain improves with rest and worsens with activities including standing, walking, and driving.Tenderness in the area behind the medial malleolus.Swelling of the feet.Forced eversion and dorsiflexion of the foot increase the symptoms.

DIAGNOSIS:

clinical examination and medical historyAnalysis of gait.Sensory evaluation.Testing for a range of motion.Muscle testing by hand.Tinel's sign and other specialized testsradiography like ultrasound, MRI, computed tomography, and electromyography (EMG).Nerve conduction investigations to evaluate the problematic foot's digital abductor and flexor muscles.

TREATMENT

Physiotherapy Management

Use of Physical agents such as:IceContrast bathsUltrasoundIontophoresisInterferential current therapyExtracorporeal shock wave.High-intensity class 4 laser.Dry needling.Orthotics and Taping:Plantar arch tapingMedial heel wedgeModified footwear.Therapeutic exercises:Calf stretching.Achilles tendon stretching.Plantar fascia stretching.Nerve mobility/glides.Tibialis posterior strengtheningTibialis posterior strengthening in weight-bearingBalancing and proprioception exercises.Manual therapy:Soft tissue massageNeural mobilization

PHARMACOLOGICAL MANAGEMENT

NSAIDsCorticosteroid InjectionsPain Medications

SURGICAL MANAGEMENT

Surgery is recommended for patients who have not responded to conservative treatments and have problems that interfere with their everyday lives. Surgical treatment options include:Posterior Tibial Nerve DecompressionCryosurgery