Tarsal tunnel syndrome (Tarsal tunnel syndrome)

Leg Tunnel Syndrome: Symptoms and Treatment

Popliteal tunnel syndrome occurs as a result of persistent or acute overstrain of ligaments and muscles, which, in turn, put pressure on the nerve. The specificity of the disease is such that it often affects professional athletes who experience excessive stress on their legs. But there may be other reasons:

• Limb injury.
• Staying in an uncomfortable position for a long time.
• Prolonged sitting position, low mobility.
• Tumors and inflammations in the nerve area.

Arthritis, osteoarthritis of the deforming type, and diabetes mellitus contribute to the occurrence of the disease. Women during pregnancy are also at risk.

It is important to recognize the disease in time in order to begin treatment as early as possible. Leg tunnel syndrome - symptoms:

• Painful numbness of the limbs.
• Feeling of tingling and burning.
• Often my legs go numb at night.
• Decreased mobility.
• Impaired sensitivity.
• Muscle weakness.

Carpal tunnel syndrome is treated with conservative methods at the initial stage. If the disease is advanced, only surgery will help. But it allows you to immediately get rid of all symptoms after rehabilitation.

Ulnar nerve compression or cubital syndrome

MRI of the hand

• Cost: 7,000 rub.

More details

Occurs in those who often bend their arm at the elbow - cyclists, programmers and others. The ulnar nerve is often affected in very thin women. In this case, pain and numbness begins with the little finger, spreading to the entire hand. The muscles on the back of the hand between the thumb and index finger become thinner and begin to work less well. In damp, cold weather the pain becomes almost unbearable.

Leg tunnel syndrome – treatment at the Surgery Center

Knee tunnel syndrome can be treated even if the patient has delayed the need to see a doctor for a long time. However, treatment is only possible with surgery. Our Surgery Center offers a full range of services necessary for diagnosis and successful treatment of the disease.

Our advantages and guarantees for patients:

• Surgeons with more than 8 years of experience.
• We specialize in the treatment of carpal tunnel syndrome.
• Painless surgery without discomfort.
• There are no hidden fees - the price already includes examination, diagnosis, surgery and subsequent hospital care.
• Convenient work schedule.
• Modern equipment.
• Full support after surgery, including communication with the surgeon or a specialized specialist.
• Possibility of cash and non-cash payments.

Patients of the clinic receive qualified medical care and a comfortable stay within the walls of the center. You can sign up for a consultation by ordering a call back on the website.

Numb feet

If a patient has a mass formation that is the cause of tarsal tunnel syndrome, removal of this formation is indicated. Otherwise, the vast majority of patients with tarsal tunnel syndrome can (and should) be treated conservatively. Surgical nerve release can be considered only in cases of failure of long-term conservative treatment in patients with positive results of nerve conduction studies.

The main goal of conservative treatment of tarsal tunnel syndrome is to try to reduce the traction effect on the nerve and other anatomical structures of the foot. In this regard, treatment is similar to that of acquired flat feet and plantar fasciitis.

It is effective to wear comfortable shoes designed to distribute the load on the foot as evenly as possible. Weight correction is recommended for overweight patients.

Custom orthopedic insoles with arch support also help distribute the loads on the foot more evenly and are effective for tarsal tunnel syndrome.

Physiotherapy is aimed at stretching the muscles of the lower leg, which indirectly helps to unload the foot.

Limiting walking will reduce the severity of symptoms, but does not combine well with weight management, if necessary (and for some patients, such restrictions are not possible at all). A more acceptable recommendation may be to limit prolonged standing in one position. This will be better than limiting those activities that involve walking.

Local administration of corticosteroids may temporarily reduce swelling of the tissue around the nerve, but it is unclear how effective this method is in the long term. In addition, such an injection carries the risk of direct nerve damage.

Surgical treatment of tarsal tunnel syndrome is not often indicated. First of all, it is indicated for patients with space-occupying formations of the tarsal canal, when removal of this formation is necessary. In other cases of tarsal tunnel syndrome, it is possible to release the canal and correct the deformities that cause compression of the nerve.

Tarsal canal release involves cutting the flexor retinaculum and freeing the nerve and its branches within the canal.

Risk factors and prevention

It is known that tarsal tunnel syndrome is more common in people who stand on their feet for a long time. Intense physical activity involving plantar flexion of the foot can also cause symptoms consistent with tarsal tunnel syndrome. A predisposing factor to its development is flat feet.

Obesity doubles the risk of mechanical overload of the foot on its own, and often it is also combined with diabetes (a complication of which is neuropathy, which makes the nerves more vulnerable to even minimal compression).

Tarsal tunnel syndrome is also thought to be frequently associated with rheumatoid arthritis, hypothyroidism, and gout.

Case study

Romani et al reported their results in a 22-year-old lacrosse player with tarsal tunnel syndrome. The player suffered a mild eversion ankle sprain that was successfully treated with conservative treatment. Following a recurrent ankle sprain, the patient made the decision to compete in the NCAA Tournament, which led to an exacerbation of symptoms and, ultimately, to surgery. The 13-week rehabilitation program included: RICE, range of motion maintenance, balance exercises, therabend exercises, aquatic therapy and walking, which eventually progressed to running. At the end of week 13, the athlete returned to lacrosse, competing at the elite level.

Dr. Karen Hudes conducted a separate case study on the conservative approach to treating TTS. A 61-year-old patient diagnosed with tarsal tunnel syndrome reported pain and discomfort in the medial ankle area (verbal rating scale 9/10). Initial treatment included orthopedic techniques for the first ten weeks, after which the patient reported little change in symptoms. Following failure of orthopedic therapy, treatments such as transverse friction massage, high-velocity, low-amplitude manipulation of the talonavicular joint, and cuboid mobilization were used twice weekly. The patient's symptoms began to improve after 3 weeks, resolved by week 6 with occasional relapses of pain, and resolved completely by week 12. The patient reported no pain during the ten-month follow-up.

Main types.

The most common type of disease is carpal tunnel syndrome - it occurs when the carpal trunk is compressed due to increased pressure inside it. Blood supply in this area decreases and the conduction of nerve impulses worsens.

In addition to the carpal tunnel, pinching can occur in the following nerve trunks:

• Elbow;
• Ladonnom;
• Bolshebertsovo;
• Luchevoy;
• Palmar medial;
• Plantar toe;
• Suprascapular (this syndrome is often found among tennis players and track and field athletes who throw spears and shot throws).

Epidemiology/Etiology

The incidence is unknown. A higher prevalence of TCS has been reported among women than among men. Moreover, this occurs at any age. Causes of TCS include:

• Repetitive activities that strain this area, such as running, long walking, or standing.
• Injuries such as fractures, dislocations, or sprains.
• Varus or valgus heel.
• Fibrosis.
• Excess body weight.
• Pathologies occupying space in the tarsal canal area, such as tumors, edema, osteophytes or varicose veins.
• Tendinitis.
• Systemic diseases that cause inflammation of the ankle joint or disorders of its innervation (for example: diabetes, arthritis).

Many cases (20-40%) are idiopathic.

Survey

It is important to take a thorough history. The physical therapist should learn about the following:

• Mechanism of injury – was there trauma, sprain or overuse?
• Duration and location of pain and paresthesia?
• Weakness or difficulty walking?
• Are back and buttock pain associated with distal symptoms?
• Does the pain get worse, stay the same, or get better?

Key symptoms

• Paresthesia or burning in the area of ​​the distal branches of the tibial nerve.
• Prolonged walking or standing often worsens the patient's symptoms.
• Dysesthesia (an abnormal or unpleasant sensation) occurs at night and can interfere with sleep.
• Muscle weakness.

Observation

• Atrophy of the abductor pollicis may be noticeable.
• Assessment of the arches of the feet.
• Position of the talus and calcaneus.

Gait Analysis

• Examine for abnormalities (excessive pronation/supination, excessive inversion/eversion, antalgic gait, etc.).

Sensitivity assessment

• Testing surface sensitivity, sense of discrimination.
• Sensitivity will be impaired in the area of ​​innervation of the tibial nerve.

Palpation

• Tenderness on palpation between the medial malleolus and the Achilles tendon (palpation is painful in 60-100% of patients).

Movement amplitude

• Focus on the range of motion of your ankle and toes.

Manual muscle testing

• Decreased strength usually occurs in the late stages of STS.
• First, the abductors of the fingers are turned off, and then the short flexors of the fingers.

Special tests

Tinnel's sign

• Percussion in the area of ​​the tarsal canal leads to the spread of paresthesia in the distal direction (occurs in more than 50% of patients).

Dorsiflexion-eversion test

• Place the patient's foot in the dorsiflexion position and hold it in eversion for 5-10 seconds. This results in the patient becoming symptomatic.

Electromyography

• The presence of an isolated lesion of the tibial nerve in the tarsal canal is confirmed by measuring the velocity of impulses along sensory and motor fibers.
• Assessment of conduction along sensory fibers of the medial and lateral plantar nerves. This is best done by recording from the tibial nerve just above the flexor retinaculum and stimulating the ball of the foot. When surface electrodes are used, responses to stimulation are of low amplitude.
• Measuring conduction velocity along motor fibers by recording the distal latency of the abductor pollicis is a much simpler but less sensitive method. An important finding of electromyography is the detection of axonal damage when readings are recorded from the distal muscles innervated by the tibial nerve.

Causes of pain in the hands

Median nerve tunnel syndrome has a number of causes and predisposing factors, namely:

• overweight;
• bad habits;
• changes in hormonal levels;
• thyroid diseases;
• dislocations, fractures, wrist sprains;
• long-term vibration effects;
• monotonous long movements of the hand and arms;
• diabetes, pregnancy, rheumatic diseases.

Carpal tunnel syndrome in children can develop with prolonged use of a computer mouse and keyboard.

Rating scales

1. Functionality Questionnaire of the Foot and Ankle (FAAM). The FAAM is a reliable, sensitive, and valid measure of physical function for people with a wide range of musculoskeletal disorders of the leg, ankle, and foot.
2. Tarsal tunnel syndrome severity rating scale.

Postoperative treatment

Diagnostics.

When a patient contacts a doctor, first of all, he must rule out other diseases that have similar symptoms - arthritis, arthrosis, various neuralgic diseases. In our clinic, diagnostic measures are selected individually for each patient. After establishing an accurate diagnosis, the doctor prescribes a treatment plan.

Among the diagnostic measures that a doctor can prescribe, the following should be highlighted:

• CT scan;
• Ultrasound studies;
• Magnetic resonance imaging;
• Radiography.

Why is carpal tunnel syndrome dangerous?

Gradually, changes characteristic of a damaged nerve develop in the hand. The median nerve controls the flexor muscles of the fingers. The first, second and third fingers are fully controlled by it, and the rest are partially controlled. In addition, this nerve is responsible for sensitivity in the hand. First, pain appears
on the inside of the wrist joint, approximately in the middle or closer to the first finger. Over time, the mobility of the fingers is lost, the hand weakens - after all, when it is bent, a sharp pain appears and the person tries to take care of it. The flexibility of the fingers is also impaired. Often with this syndrome, the nutrition of the tissues in the hand is disrupted - the skin turns pale, and increased sweating appears.

Characteristics/Clinical picture

Common symptoms of TTS include paresthesia (burning, numbness, or tingling) in the tibial, lateral, and/or medial plantar nerves. There may be burning, tingling, or pain along the medial ankle and plantar surface of the foot, as well as localized tenderness behind the medial malleolus. Symptoms usually worsen with forced eversion and dorsiflexion of the foot. When the medial plantar nerve is isolated, patients may experience stabbing pain in the midfoot, which is typically seen in middle-aged runners. If the condition is progressive or chronic, there may be muscle weakness of the abductors and flexors of the fingers. In more serious cases, muscle atrophy occurs. Patients may also experience night pain that reduces sleep quality, as well as severe pain when walking for long periods of time.

At-risk groups.

Among the risk factors that most influence the appearance of carpal tunnel syndrome are:

• Activities involving the performance of repetitive movements of the same type (risk group: programmers, guitarists, painters, tennis players, hairdressers, etc.);
• Elderly age;
• Endocrine diseases of the body (diabetes mellitus, etc.);
• Microtraumas of the ligamentous apparatus, joints;
• Hereditary predisposition;
• Diseases of the musculoskeletal system;
• HIV, other autoimmune diseases.

Other causes of carpal tunnel syndrome include:

• Tumors and edema;
• Increased physical activity;
• Metabolic disorders;
• Prolonged fasting;
• Wearing tight clothing;
• Injuries;
• Pregnancy;
• Unskilled surgical intervention.