Tarsal Tunnel Release: Getting The Facts About The Procedure

This week, I evaluated a patient for low back pain. When examining his feet and testing his nerves, I noticed a large scar on the inside of his ankle. When asked, the patient explained his foot was going numb so he had a tarsal tunnel release. 

Unfortunately, the surgery did not help because the nerve damage was in his back and not his foot! Today, let’s dive into what tarsal tunnel syndrome is and how to tell if you need a release or not!

What Is Tarsal Tunnel Release?

Tarsal tunnel release is a surgical procedure that is used to treat tarsal tunnel syndrome. During the procedure, the surgeon makes an incision in the skin and soft tissue on the inside of the ankle to access the tarsal tunnel. The surgeon then cuts the ligament that forms the roof of the tunnel, which helps relieve pressure on the tibial nerve.

The procedure can be performed using a traditional open incision or through minimally invasive techniques, such as endoscopy. The type of surgery used will depend on the severity of the tarsal tunnel syndrome and the preference of the surgeon.

After the procedure, the incision is closed with stitches or staples, and the foot is wrapped in a bandage or cast to protect it during the healing process. Patients may need to wear a splint or brace for several weeks to support the ankle and foot in order to prevent the tibial nerve from becoming compressed again.

What Tarsal Tunnel Release Treats

Tarsal tunnel syndrome is a medical condition that occurs when the tibial nerve, which runs along the inside of the ankle, becomes compressed or squeezed as it passes through a narrow tunnel called the tarsal tunnel. This can lead to pain, numbness, tingling, or weakness in the foot and ankle.

The tarsal tunnel is a narrow passageway located on the inside of the ankle, just behind the bony bump called the medial malleolus. It is surrounded by bones, ligaments, and other soft tissues, which can put pressure on the tibial nerve if it becomes inflamed or swollen.

The symptoms of tarsal tunnel syndrome can range from mild to severe and may include:

• Pain or burning sensation in the foot and ankle
• Numbness or tingling in the sole of the foot, toes, or heel
• Weakness in the foot or ankle
• Swelling or inflammation in the ankle
• Difficulty walking or standing for long periods of time

Treatment for tarsal tunnel syndrome may include rest, ice, compression, elevation, and anti-inflammatory medications to reduce swelling and pain. Physical therapy or exercises may also be recommended to stretch and strengthen the muscles in the foot and ankle. In more severe cases, surgery may be necessary to relieve pressure on the tibial nerve.

What To Consider Before Undergoing Tarsal Tunnel Release Surgery

Tarsal tunnel release surgery can be a successful treatment for tarsal tunnel syndrome, particularly when conservative treatments such as rest, physical therapy, and medication have failed to relieve symptoms. The success of the surgery depends on the severity of the tarsal tunnel syndrome, the surgical technique used, and the patient’s individual factors.

However, it is important to note that as with any surgery, there are potential risks and complications associated with tarsal tunnel release. These can include infection, bleeding, nerve damage, scarring, and failure to relieve symptoms.

Additionally, some patients may require more surgeries or ongoing treatment to manage symptoms and prevent a recurrence of tarsal tunnel syndrome.

As with any surgical procedure, tarsal tunnel release surgery carries potential risks and side effects, which can include:

• Infection: There is a risk of infection with any surgery. Signs of infection include redness, swelling, warmth, or drainage from the incision site.
• Bleeding: The surgery involves cutting into tissues, which can cause bleeding. In rare cases, severe bleeding may require additional surgery to control.
• Nerve Damage: The tibial nerve, which is the nerve affected by tarsal tunnel syndrome, runs through the tarsal tunnel. During surgery, there is a risk of damaging this nerve, which can lead to numbness, weakness, or pain.
• Scarring: Surgery always results in some degree of scarring. In rare cases, excessive scarring may cause nerve compression, leading to symptoms similar to tarsal tunnel syndrome.
• Failure to Relieve Symptoms: In some cases, surgery may not fully relieve symptoms, and additional treatment may be necessary.
• Anesthesia Complications: Anesthesia used during the surgery can cause complications, such as allergic reactions, breathing difficulties, or heart problems.
• Blood Clots: Patients who undergo surgery are at risk of developing blood clots in their legs. This can lead to a serious complication known as deep vein thrombosis.

The recovery time after a tarsal tunnel release surgery can vary depending on the individual patient and the severity of their condition. However, most patients can expect to return to their normal activities within several weeks to a few months following the surgery.

During the first few days after the surgery, patients may experience pain, swelling, and bruising in the affected foot and ankle. They may need to use crutches or a walker to avoid putting weight on the affected foot. The doctor may prescribe pain medication and recommend using ice to reduce swelling and relieve pain.

Patients will need to keep the incision site dry and clean to prevent infection, and they may need to wear a splint, cast, or special boot to protect the foot and ankle during the healing process. They will also need to avoid strenuous activities, such as running or jumping, for several weeks after the surgery.

The Benefits Of Non-Surgical Treatment For Tarsal Tunnel Syndrome

Non-surgical treatments for tarsal tunnel syndrome can be effective in reducing pain and discomfort and improving the function of the foot and ankle. Some of the benefits of non-surgical treatments include:

• Reduced Pain: Non-surgical treatments such as rest, ice/heat, and physical therapy can help reduce pain and inflammation in the foot and ankle.
• Improved Mobility: By reducing pain and inflammation, non-surgical treatments can improve mobility and range of motion in the foot and ankle, allowing patients to perform daily activities with less difficulty.
• Fewer Complications: Non-surgical treatments carry fewer risks and potential complications than surgery, such as infection, bleeding, and nerve damage.
• Lower Cost: Non-surgical treatments are often less expensive than surgery and may be covered by insurance. Even with many self-pay procedures, they still cost less than surgery due to many of the high deductible plans.  Even if you meet the deductible, most plans still cost 80/20 for a cost which can still be very $!
• Non-invasive: Non-surgical treatments do not involve cutting into tissues or bones, making them a less invasive option for patients who prefer to avoid surgery.

Better Overall Health: Non-surgical treatments such as physical therapy can help improve overall health and fitness, leading to a better quality of life.

Overall, non-surgical treatments can be an effective first-line treatment option for patients with tarsal tunnel syndrome, particularly in milder cases.

However, the choice of treatment will depend on the individual patient’s symptoms, medical history, and preferences. Patients should discuss the benefits and risks of non-surgical treatments with their doctor to determine the best course of action.

Alternatives To Tarsal Tunnel Release Surgery

Being the clinical headquarters of Regenexx, one of our focuses and missions is to continue to innovate in the orthopedic space.  With that said, treating nerve injuries and compressive neuropathies can cause havoc and disruption in patients’ lives. 

As an alternative to traditional surgical options when conservative treatments fail, we developed peripheral nerve hydro dissections using advanced ortho-biologic to help 1. Decompress the nerve and 2. Assist in nerve regeneration/repair!

Platelet-Rich Plasma Injections

The best biologic for tarsal tunnel syndrome would be PRP and more specifically platelet lysate.

What is Platelet Lysate?

Watch this video to learn more about it.

Bone Marrow Concentrate (BMAC)  

While there is far fewer data to support its use for tarsal tunnel syndrome, PRP remains the best biologic to consider when seeking an option for a non-surgical treatment.

 A quick search of current literature on biologics for the tarsal tunnel (1). This study found that PRP injections were effective in improving pain, function, and quality of life in patients with tarsal tunnel syndrome (2).

This case report described a patient who underwent stem cell therapy for tarsal tunnel syndrome and experienced significant improvement in pain and function (3). This pilot study found that PRP injections were effective in reducing pain and improving function in patients with tarsal tunnel syndrome.

Consider All Treatment Options Before Committing To A Treatment Plan

If you have been diagnosed with tarsal tunnel syndrome or have been experiencing symptoms of tarsal tunnel syndrome, contact our office today to set up an evaluation with one of our experts!

References:

1. Lee CH, Lee SY, Huang GS, et al. Platelet-rich plasma injections for the treatment of tarsal tunnel syndrome: a randomized controlled trial. J Orthop Surg Res. 2020;15(1):437. doi:10.1186/s13018-020-01960-7
2. Barp EA, de Oliveira RA, Mazzer N, et al. Treatment of tarsal tunnel syndrome with bone marrow-derived mononuclear cells. Case report. Acta Ortop Bras. 2017;25(6):279-282. doi:10.1590/1413-785220172506166046
3. Hsu WC, Chang WH, Hsu SH, et al. Autologous platelet-rich plasma injection for the treatment of tarsal tunnel syndrome: a pilot study. Clin Drug Investig. 2014;34(10):745-751. doi:10.1007/s40261-014-0229-9