Tarsal Tunnel Release

When conservative treatments such as cortisone injection, physical therapy, orthotics, and medications fail to provide relief, surgical intervention may be necessary. Tarsal tunnel decompression via an open procedure is an effective treatment to alleviate the pressure on the nerve and relieve symptoms. This blog will discuss the procedure, recovery, potential risks, and the importance of addressing underlying vascular issues.

Understanding Tarsal Tunnel Syndrome

The tarsal tunnel is a narrow space on the inside of the ankle, through which the posterior tibial nerve travels. Compression of this nerve can occur due to various factors, including:

• Anatomical Variations: Abnormalities in the structure of the ankle can contribute to nerve compression.
• Injuries: Trauma to the ankle can lead to swelling and increased pressure within the tarsal tunnel.
• Inflammatory Conditions: Conditions like arthritis can cause swelling and nerve compression.
• Vascular Issues: Poor blood flow and varicosities in the area can exacerbate symptoms and contribute to nerve compression.

The Procedure: Tarsal Tunnel Decompression

Tarsal tunnel decompression involves surgically releasing the structures that compress the posterior tibial nerve, providing relief from symptoms.

Step-by-Step Procedure

1. Preoperative Planning: A detailed clinical evaluation, diagnostic injections, along with occasionally imaging studies such as MRI or ultrasound, helps confirm the diagnosis and plan the surgical approach.

2. Anesthesia: The procedure is performed under general anesthesia, depending on the patient’s preference and medical condition.

3. Incision: An incision is made on the inside of the ankle, allowing direct access to the tarsal tunnel.

4. Nerve Decompression: The surgeon carefully identifies and releases the flexor retinaculum, a band of tissue that forms the roof of the tarsal tunnel. Any other structures compressing the nerve, such as abnormal tissue or bone spurs, are also addressed.

5. Closure: The incision is closed with sutures, and a sterile dressing is applied. A medical boot is provided to protect the foot during the initial recovery period.

Recovery and Rehabilitation

Recovery from open tarsal tunnel decompression involves a structured rehabilitation program to ensure optimal outcomes.

1. Immediate Post-Operative Period (0-2 Weeks):

   • Patients are allowed immediate weight-bearing in a medical boot.
   • Pain and swelling are managed with prescribed medications, ice, and elevation.

2. Transition Period (2+ Weeks):

   • Patients transition to regular shoes as tolerated, with emphasis on supportive, comfortable footwear.
   • Gradual return to normal activities is encouraged, avoiding high-impact activities until fully healed.

Risks and Recurrence

While tarsal tunnel decompression is generally successful, there are potential risks and complications, including:

• Recurrence of Symptoms: In some cases, symptoms may recur due to scar tissue formation.
• Underlying Vascular Issues: Poor blood flow can exacerbate symptoms and contribute to nerve compression, making it essential to address any vascular problems concurrently.

Importance of Addressing Vascular Issues

Adequate management of vensou insufficiency and varicosities is crucial. Vascular issues, such as varicose veins or peripheral artery disease, can worsen tarsal tunnel syndrome. Addressing these issues can improve surgical outcomes and reduce the risk of recurrence.

Preventive Measures: Custom Orthotics

Wearing custom orthotics post-surgery can provide several benefits:

• Support and Alignment: Orthotics help maintain proper foot alignment and support the arch, reducing pressure on the posterior tibial nerve.
• Shock Absorption: They cushion the foot, absorbing shock and reducing impact during walking and other activities.
• Preventive Care: By addressing biomechanical imbalances, orthotics can help prevent conditions that may contribute to tarsal tunnel syndrome.

Conclusion

Open tarsal tunnel decompression offers a reliable solution for individuals suffering from chronic tarsal tunnel syndrome when conservative treatments have failed. With a structured recovery plan, addressing underlying vascular issues, and using custom orthotics, patients can achieve lasting relief and return to their active lifestyles more quickly.

If you are experiencing persistent pain, tingling, or numbness in your foot and conservative treatments have not provided relief, contact us for a consultation to discuss whether tarsal tunnel decompression is right for you. At Acacia Foot and Ankle Surgeons, we are dedicated to providing the highest standard of care and advanced surgical solutions to help you get back on your feet. Contact us today to schedule a consultation.