The largest nerves in the foot run from the inner side of the ankle down to the arch. This is called the posterior tibial nerve. This nerve goes through the tarsal canal which has a combination of tendons, veins, and arteries. Often this area gets compressed or damaged leading to pain to the arch and heel of the foot called Tarsal Tunnel Syndrome (TTS).
An accurate clinical diagnosis is important in determining if TTC is the problem, as the initial symptoms can be similar to plantar fascia pain. Often it is mis-diagnosed and in those cases, patients usually have a lack of improvement despite undergoing treatments Clinically patient will often elicit a positive Tinel’s signs which is a shooting pain that is positively produced by compression of the tibial nerve along the medial aspect of the ankle. This is test performed by your physician by tapping in specific places to determine if there is pain associated with the tibial nerve. To confirm a diagnoses nerve conduction velocity (NCV) and Electromyogram (EMG) testing needs to be performed. The testing should be performed by a professional Neurologist for the most accurate readings, and these tests may be ordered by your physician if he or she suspects TTC. These tests determine the conduction along the nerve and the muscles they innervate and any discrepancies along the nerve will suggest the source of the nerve damage. MRI can be used to diagnose. In an MRI we are looking for any soft tissues in the tarsal canal that can be impinging on the Tibial nerve, as well as any muscle loss in the foot, which nerve damage can cause. Extremity MRI is available from Weil Foot & Ankle Institute, making scheduling of these tests convenient and quick.
