Peripheral neuropathy, commonly known as nerve pain, is often the result of damage to the nerves in your feet. It can easily cause weakness, numbness, and pain to the affected area, usually your hands and your feet. Those suffering from nerve pain often describe the pain as stabbing, burning, or tingling and can make walking or conducting normal activities.
If you are experiencing peripheral neuropathy in your feet, there are treatments available to ease the pain so you can get on with your life. NEPA Podiatry can help. Schedule an appointment today for more information.
What Is Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome is a compression of the tibial nerve at the inner part of the ankle. Nerve compression can produce symptoms anywhere along the path of the nerve. In tarsal tunnel, the pain can occur at the ankle, the bottom of the foot, and the heel or shoot up the inside of the leg and into the knee.
Tarsal tunnel syndrome is similar to carpal tunnel syndrome in the wrist. Both disorders arise from the compression of a nerve in a confined space and are linked to repetitive abnormal motion.
Tarsal tunnel syndrome is caused by anything that produces compression on the tibial nerve. The compression can occur due to anything taking up more space in the tarsal tunnel, closing down of the space, or enlarging of the nerve:
- Things that occupy the tarsal tunnel can range from ganglion cysts, scar tissue, a rare extra muscle, aneurysms, or even bones. The tarsal tunnel has limited room and does not stretch. This causes the tunnel to have less room and the nerve can get squeezed.
- The tarsal tunnel space can be closed down for several reasons. Among the most common reason is a flatfoot. As the foot flattens, the heel rotates inward causing the inside of the ankle to stretch and close down the tarsal tunnel. Additionally, any trauma to the foot and ankle especially injury resulting in fracture can result in the tunnel closing down and squeezing the nerve.
- Tibial nerve enlargement can cause nerve compression in the tarsal tunnel by enlarging so large the tunnel can no longer accommodate the needed space the nerve requires. There are several conditions that can cause this but the most common is diabetes. Diabetic nerve enlargement is especially concerning as this is part of diabetic neuropathy that becomes complicated by nerve compression in the tarsal tunnel. This is known as double crush syndrome and can hasten complications related to diabetic nerve problems.
Patients with tarsal tunnel syndrome experience one or more of the following symptoms:
- Tingling, burning, or a sensation similar to an electrical shock in the foot, heel, ankle, or leg
- Numbness, especially in the foot and toes
- Pain, including shooting, squeezing, or pain that changes in nature. This occurs mostly during activity or at night disrupting sleep.
It is important to seek treatment if any of the symptoms of tarsal tunnel syndrome occur. If left untreated, the condition progresses and may result in permanent nerve damage. In addition, because the symptoms of tarsal tunnel syndrome can be confused with other conditions, proper evaluation is essential so that a correct diagnosis can be made and appropriate treatment initiated.
The foot and ankle surgeon will examine the foot to arrive at a diagnosis and determine if there is any loss of feeling. Additionally, the doctor will hold the foot and tap on the ankle to see if the symptoms can be reproduced. Pressing on the area can help to help determine if a small mass is present.
Advanced imaging studies may be ordered if a mass is suspected or if initial treatment does not reduce the symptoms. Studies used to evaluate nerve problems—electromyography and nerve conduction velocity (EMG/NCV)—may be ordered if the condition shows no improvement with non-surgical treatment.
A variety of treatment options, often used in combination, are available to treat tarsal tunnel syndrome. These include:
- Rest. Staying off the foot prevents further injury and encourages healing.
- Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
- Physical therapy. Ultrasound therapy, exercises, and other physical therapy modalities may be prescribed to reduce symptoms.
- Injection therapy. Injections of a local anesthetic provide pain relief, and an injected corticosteroid may be useful in treating the inflammation.
- Orthotic devices. Custom shoe inserts may be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve.
- Shoes. Supportive shoes are recommended.
- Bracing. Patients with flatfoot may be fitted with a brace to reduce deforming forces on the ankle.
When is Surgery Needed?
The decision for surgery is based on many factors such as the severity of symptoms, EMG/NCV results, and or failure of conservative treatments. Surgery generally consists of cutting the connective tissue that forms the tunnel. The general goal is to open the tunnel and remove the forces causing nerve compression.
Morton's Neuroma is a painful condition that affects the ball of the foot, usually between the third and fourth toes. The condition occurs when the surrounding tissue of the nerves that lead to the toes thickens. You will feel sharp, burning pain In the ball of your foot, as If you were standing on a hard object like a marble or pebble. The toes may also experience stinging, burning, tingling, or numbness.
Morton's neuroma is often the result of when one of the nerves that leads to the toes is subjected to irritation, pressure, or injury. Certain conditions have been associated with Morton's neuroma, including:
- High heels — High heel shoes or shoes that don't fit properly put pressure on the ball of the foot. Switching to low heel shoes with a wider toe box can provide relief.
- Sports — Sports that involve high impact on the foot, such as running or jogging, may subject your feet to repetitive impact. Sports, where tight shoes are worn, can pressure your toes.
- Foot deformities — Deformities such as high arches, bunions, hammertoes, or flat feet significantly increase the chance of Morton's neuroma.
The severity of the condition determines what treatment you will receive. Nonsurgical treatments usually include:
- Arch supports — Arch supports and foot pads inside your shoes to reduce pressure on the affected nerve.
- Injections — Steroid injections into the painful area can help some people.
- Decompression surgery — In some cases, cutting the ligaments and other structures binds the foot bones in the front of the foot together by a surgeon.
- Removing the nerve — If other treatments fail, removal of a growth surgically may be necessary.
The inability to lift the front of one or both feet is called foot drop, also called "drop foot." As a result, while walking, the toes drag along the ground.
While there are many causes of foot drop, generally, it stems from paralysis or weakness of the muscles in the foot. It is a symptom of an underlying issue and not a disease in itself. Such issues that can cause foot drop include:
- Nerve injury — A branch of the sciatic nerve that wraps from the back of the knee to the front of the shin is called the peroneal nerve. An injury to this nerve is a common cause of drop foot.
- Brain or spine disorder — Neurological conditions that contribute to foot drop include:
- Multiple sclerosis
- Cerebral palsy
- Charcot-Marie-Tooth disease
- Muscle disorder — Progressively weakening and deteriorating muscle conditions such as:
- Muscular dystrophy
- Amyotrophic lateral sclerosis (Lou Gehrig's disease)
The cause of foot drop will determine the appropriate treatment. The chances of recovery may improve with early treatment. Treatment may include:
- Lightweight braces — Lightweight braces are the most common treatment.
- Shoe inserts (orthotics) — To adjust the position of the foot.
- Physical therapy — PT is used to strengthen the muscles in the leg and the foot.
- Surgery — To decompress or repair a damaged nerve, surgery may be recommended.
If you are experiencing any of the above, contact NEPA Podiatry today to schedule an appointment or for more information.
This page is for information/educational purposes and does not constitute replacement for recommended diagnosis or treatments.