With India having largest number of diabetes in the world, the tarsal tunnel and the sensation of the plantar foot has acquired great importance in management and prevention of foot ulcers in this vast population. This neglected topic is of great importance in these patients as more than half of the long standing diabetics have diminished sensations over their soles. Diabetic angiopathy though is responsible for majority of cases of foot ulcers; diabetic neuropathy is almost equally responsible for these problems.
Though the sensory neuropathy cannot be reversed due to changes in the nerve conduction by relieving the external pressure the progression of neuropathy can be definitely reduced. This has duel advantages. Retaining the remaining sensation for longer period. Prevention of neuropathic ulcers. Following discussion will give a brief overview of the problem and its possible treatment.
What is the tarsal tunnel?
Tarsal tunnel is fibro-osseous tunnel on the medial side of the foot formed
What is tarsal tunnel syndrome?
Tarsal tunnel syndrome results when the posterior tibial nerve is compressed within the tarsal tunnel. This condition is very similar, in mechanism, to carpal tunnel syndrome in the wrist. Both of these conditions result when a nerve is pinched within a confined space. The tarsal tunnel, as mentioned previously, has little room to give. When the space becomes tight, the tibial nerve is pinched.
What are the symptoms of tarsal tunnel syndrome?
When the posterior tibial nerve is compressed in the tarsal tunnel, patients commonly complain of numbness over the bottom of the foot, as well as complaints of pain, burning, and tingling over the base of the foot and heel. Occasionally, tarsal tunnel syndrome is confused with plantar fasciitis, or heel spurs.
What is the cause of tarsal tunnel syndrome?
The cause of tarsal tunnel syndrome is unknown in most cases, but can be the result of fractures, bone spurs, ganglions and other benign tumours, muscle impingement, or foot deformities, in diabetic patients the nerves are swollen and more likely to get involved.
How is tarsal tunnel syndrome diagnosed?
Because of the symptoms of tarsal tunnel syndrome, most patients describe a similar history of symptoms. However, as mentioned previously, the diagnosis of tarsal tunnel syndrome can be confusing. Tapping on the nerve as it passes through the tarsal tunnel, the so-called "Tinel’s Test," may create the symptoms and indicate tarsal tunnel syndrome as the cause of the problem. Electro diagnostic studies that detect how well a pulse of electricity conducts through a nerve may also help with the diagnosis if there is any reason for confusion.
What is the treatment of tarsal tunnel syndrome?
Treatment begins with anti-inflammatory medications, and possibly an injection of cortisone into the area around the nerve. Orthotics and changes in footwear may also help to relieve the symptoms.
If none of these measures helps, then a procedure called a tarsal tunnel release may be necessary. This is a surgical procedure performed in the operating room and it lasts about 30 to 45 minutes. When a tarsal tunnel release is performed, an incision is made to open up the tarsal tunnel and decrease pressure on the posterior tibial nerve. This surgery is also very similar to a carpal tunnel release in the wrist.
Typical neuropathic ulcer