Carpal tunnel syndrome is compression of the median nerve at the level of the wrist with resultant hand and wrist pain. Tarsal tunnel syndrome (TTS) – also called tibial neuralgia – is the equivalent in the ankle.
What is Tarsal Tunnel Syndrome (TTS)?
TTS is compression of the tibial nerve as it passes through the tarsal tunnel at the ankle. The tarsal tunnel is located behind the medial malleolus, the bump on the inside of the ankle.
Causes of TTS
TTS can be caused by a variety of diseases and circumstances that strain or compress the tibial nerve, including:
Inflammation caused by an ankle sprain
Arthritis or diabetes – swelling of feet
Symptoms of Tarsal Tunnel Syndrome
Patients typically complain of pain, numbness, tingling, or burning sensation in the foot, including in the big toe and the first two to three toes.
Some patients complain of pain at the ball of the foot that is often worse when they are wearing shoes. The symptoms often occur during the night and may be more noticeable after resting or sleeping. Symptoms can also worsen during prolonged standing, walking, or any other activity in which the ankle is bearing weight.
Treatment Options for TTS or Tibial Neuralgia
At the Centeno-Schultz Clinic, the first step is a complete history and thorough examination. Some patients may have a Tinel’s sign. Ultrasound examination provides a dynamic picture of the structures within the tarsal tunnel including scar tissue and tendon irritation. Hydrodissection is a non-surgical treatment option for tarsal tunnel syndrome in patients who have failed conservative therapy.
RICE – rest, ice, compression, elevation
Surgery for tarsal tunnel syndrome is performed endoscopically, and the flexor retinaculum is released and reconstructed (1).
Regenerative Treatment Options
Hydrodissection with prolotherapy
Hydrodissection with platelet-rich plasma
Nerve Hydrodissection is a medical procedure that aims to free up scar tissue or adhesions on a given peripheral nerve. The procedure utilizes ultrasound guidance to visualize both the needle and the targeted nerve. Medication is then injected through the needle to free up the scar tissue. Nerve Hydrodissection is a minimally invasive treatment option for many peripheral nerves that are compressed or entrapped by scar tissue.Pain is an uncomfortable and at times painful sensation. It varies significantly from patient to patient. There are many different types of pain which include inflammatory, nociceptive, and neuropathic. Neuropathic pain is pain that arises from nerve compression or injury.
The other day I was evaluating a patient and reviewing the treatment options for their spine condition. After discussing prior treatments, we got to the topic of medications taken for pain relief. She explained that she mainly utilized anti-inflammatory (NSAID) medications and then she told me to hold much she takes and has been for many years…..she takes close to 2 grams (2000 milligrams) on a daily basis which equated to about 9-10 capsules of medication per day. I was shocked, considering she was pre-diabetic and with high blood pressure plus the kicker of it is that her PCP (primary care physician) is ok with this…
Peripheral nerves are comprised of various combinations of motor, sensory, and autonomic neurons. Nerve injuries are a common condition with a broad range of symptoms depending on the severity of nerve damage which presents various challenges to patients, ranging from mild discomfort to life-long impairment. PRP for nerve damage has been shown to be effective. Let’s dig in. Nerve injuries can be classified based on the severity of damage and which structures in the nerve have been damaged. The most severe case is the complete transection of the nerve, called neurotmesis. The most common is neuropraxia from acute or chronic compression of the nerve.
Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…
My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.
Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.
Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.
Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…
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Dr. Pitts Talks About PRP for UCL Injury as an Alternative to Tommy John Surgery Transcript Hi everybody. This is Dr. John Pitts with the Centeno-Schultz Clinic, where we lead and invented much of the field of Interventional Orthopedics and regenerative medicine. Mainly we treat most musculoskeletal and orthopedic problems with injections of your own … Continued
Nerves typically become injured via compression. They get compressed in fascial layers. The compression usually happens through scar tissue formation, bone spurs, and tight muscles can compress the nerves. Tight muscles can also push the nerves into a bony prominence, or get stretched around a bone. So What Is a Hydrodissection? Non-Surgical Peripheral Nerve Treatment … Continued
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Dr. Markle discusses tibial nerve injury – what that means, when you need surgery, and how to avoid surgery. Transcript: Introduction Hello, Dr. Markle of Centeno-Schultz Clinic, and today we’re going to be talking about how to treat tibial nerve injury. We’ll be discussing exactly what is the tibial nerve, the muscles the tibial innervates, … Continued
Yoshida A, Okutsu I, Hamanaka I. Endoscopic tarsal tunnel syndrome surgery using the Universal Subcutaneous Endoscope system. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2015;3:1-5. Published 2015 Nov 2. doi:10.1016/j.asmart.2015.09.001