yogabook / pathologie / tarsal tunnel syndrome
Contents
tarsal tunnel syndrome / posterior tibial neuralgia)
Definition of
Nerve compression syndrome of the tibial nerve, which is compressed in the tarsal tunnel formed by a process and a retinaculum behind/under the medial malleolus, analogous to carpal tunnel syndrome. Less common is anterior tarsal tunnel syndrome with compression of the profundus fibular nerve
ICD G57
Cause
– Behavior
- constricting tight high shoes (mountain boots, ski boots)
- Muscle growth through intensive training
– traumatic
- Supination trauma with distortion
– Musculoskeletal system
- Arched flat foot, hindfoot valgus
- Malposition of the ankle joint due to osteoarthritis
- Ankle fractures
- Bone spurs
- Edema and swelling, e.g. after joint distortion or in the case of heart or kidney disease
- Arthritis
- Tendovaginitis in the tarsal tunnel
– Dispositional diseases
- perineural inflammation
- Diabetes
- Hypothyroidism
- RA
- Gout
- Varicose veins
Predisposing
- Long sessions on the cross trainer, especially if you have bent feet (also on both sides)
Diagnosis
- Test for knocking pain
- Test for pressure pain
- if necessary, nerve conduction velocity, EMG
- X-ray, MRI
- possibly reduced sweat secretion
- Tests and signs: Tinel sign, dorsiflexion eversion test, triple compression test
Symptoms
- Shooting, usually burning or tingling pain in the foot, from the inner ankle towards the sole of the foot
- Numbness (especially on the sole and the medial edge of the foot) up to paresis
- Formication, burning, can extend to the heel, instep or toes
- possibly night pain with radiation to the foot and lower leg
- Pain may increase under stress and during the course of the day, improvement at rest; with advanced disease pain also at rest
- Massage improves the symptoms
Complications
- Atrophy of the foot sole muscles
- Risk of falling due to unsteady gait
- irreversible atrophy of the nerve
Therapy
- Insoles to lift the medial edge of the foot
- KG
- NSAIDs; local anesthetic, possibly with cortisone
- If the cause is flat foot: insoles or surgery
- OP if necessary