Tarsal Tunnel Syndrome

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:

Flat feet
Fallen arches
Inflammation caused by an ankle sprain
Arthritis or diabetes – swelling of feet
Bone spur
Ganglion cyst

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.

Conservative Therapy

Physical therapy
RICE – rest, ice, compression, elevation
Medication

Surgery

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

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.

NSAIDs

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…

PRP for Nerve Damage

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.

Our Doctors Who Treat Tarsal Tunnel Syndrome

Christopher J. Centeno, MD

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…

John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…

John Pitts, M.D.

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.

Jason Markle, D.O.

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.

Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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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