Minimally invasive treatment of tarsal tunnel syndrome with Dr. Paul Ledesma, DPM

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- Tarsal tunnel syndrome is sometimes a challenging condition to identify and treat. Tarsal tunnel syndrome causes an electrical or burning pain on the inside ankle that travels into the foot. Tarsal tunnel syndrome is caused by compression of a nerve on the inside of your foot. The nerve is sometimes compressed by deformity or masses, but Tarsal tunnel syndrome is most often caused by compression of soft tissues in the ankle.

The diagnosis of tarsal tunnel syndrome requires a history, physical examination, and sometimes imaging studies and electromyograms. Doctors typically start by getting an x-ray of your ankle to see if you have a deformity or mass. In some cases, magnetic resonance imaging of the ankle is needed to figure out the cause of the compression. In addition to the typical history, the diagnosis of tarsal tunnel syndrome requires a physical examination by a foot specialist (podiatrist, orthopedic surgeon), or a doctor who specializes in nerve problems (neurologist, physiatrist). An electromyogram test is sometimes done to confirm the diagnosis.

The first step in the treatment of tarsal tunnel syndrome is conservative therapy. Foot pain caused by tarsal tunnel syndrome can often be relieved by conservative therapies. Podiatrists usually recommend starting treatment by avoiding movements that hurt, orthotics, and non-steroidal anti-inflammatory drugs like Aleve and Ibuprofen. Unfortunately, many people do not get relief from their foot pain due to tarsal tunnel syndrome despite these conservative treatments, and additional treatment is needed to relieve the pain.

When conservative treatments fail people with foot pain due to tarsal tunnel syndrome should consider surgical treatment. By releasing the tissue around the nerve, a podiatrist can relieve the pressure on the nerve. Most people have heard of carpal tunnel surgery in the hand. Tarsal tunnel release is a similar procedure, except that it is done in the foot.

New techniques using an endoscope can make tarsal tunnel surgery much less invasive than it was in the past. In order to free the nerve compression in the foot surgeons used to have to make a long incision several inches all the way from the ankle down onto the foot. That is no longer necessary. Using an endoscope, the decompressive surgery to relive tarsal tunnel syndrome can be done today using an incision that is less than an inch. Endoscopic tarsal tunnel decompression surgery is also called minimally invasive tarsal tunnel decompression surgery. Minimally invasive tarsal tunnel surgery makes recovery faster and easier than legacy surgery. Most doctors restrict their patients from walking for 2-4 weeks after traditional tarsal tunnel decompression surgery. After endoscopic tarsal tunnel decompression surgery patients can walk right away, without restriction.

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