Tarsal Tunnel, Baxter’s Nerve and Plantar Fascial Release

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Tarsal tunnel syndrome is a rare disorder caused by damage to the tibial nerve or its branches, usually due to compression as it passes through the tarsal tunnel (entrapment neuropathy). The tarsal tunnel is a narrow passageway bound by bone and soft tissue that lies on the inside of the ankle. The tibial nerve (as well as certain blood vessels and tendons) passes through the tarsal tunnel. However, the term tarsal tunnel syndrome is often broadly applied to any pain along the tibial nerve, which can result from a multitude of causes. Individuals with tarsal tunnel syndrome may experience pain, burning, or a tingling sensation along the tibial nerve.

Plantar Fascial Wendy NetherySigns & Symptoms

The specific symptoms of tarsal tunnel syndrome can vary from one person to another. In some cases, symptoms can develop suddenly, and in others gradually. Some affected individuals may experience a sharp, shooting pain along the tibial nerve. This nerve branches off from the sciatic nerve and runs down the lower leg to the ankle and then the foot. Pain can be severe enough to cause a person to limp. Affected individuals may describe a radiating pain that cannot be localized to one spot. In addition to or instead of pain, affected individuals may experience numbness of the affected area or a burning or tingling sensation (paresthesia), which is often described as similar to “pins and needles”. In some individuals, symptoms may affect one spot such as the inside of the ankle. In other individuals, symptoms can affect the ankle, heel and foot. For example, pain may radiate from the ankle down to the heel or even the foot, depending on which section of the nerve is affected. Less frequently, pain may radiate up from the ankle to the calf. The symptoms of tarsal tunnel syndrome are often worsened by activity such as prolonged standing or walking. Consequently, pain may worsen throughout an active day. Symptoms are usually relieved by rest. However, as the disorder progresses, some affected individuals have reported pain that occurs during rest or at night when attempting to sleep.

Causes

Tarsal tunnel syndrome can be caused by any condition that causes compression of the tibial nerve or its branches as it passes through the tarsal tunnel. A wide variety of conditions can cause tarsal tunnel syndrome including space-occupying lesions or masses, which may increase pressure in the tunnel. Such lesions include tumors consisting mainly of fat tissue (lipomas), tumors consisting of nerve fibers and ganglion cells (gangliomas) and tumors of the nerve sheath (schwannomas). Additional conditions that can cause tarsal tunnel syndrome include a benign bony growth in the tarsal tunnel (exostosis), enlarged (varicose) veins and inflammation of the synovial membrane (proliferative synovitis). Certain injuries or trauma such as an ankle sprain, fracture or valgus foot deformity may cause inflammation and swelling that can lead to tarsal tunnel syndrome. In addition, certain disorders such as diabetes and arthritis can also cause inflammation and swelling that can lead to tarsal tunnel syndrome. Individuals who have severely flat feet (pes planus) are at a greater risk of developing tarsal tunnel syndrome than the general population because the flattened “fallen” arches can stretch the tibial nerve.

Affected Populations

The incidence and prevalence of tarsal tunnel syndrome is unknown. The disorder is believed to affect males and females in equal numbers. Related Disorders Symptoms of the following disorders can be similar to those of tarsal tunnel syndrome. Comparisons may be useful for a differential diagnosis. Plantar fasciitis is a common condition characterized by inflammation of the thick band of tissue which runs along the bottom of the foot (plantar fascia). The plantar fascia supports the arch of the foot and acts as a shock absorber. Plantar fasciitis is a common cause of heel pain and is often described as a sharp pain in the heel. Pain associated with plantar fasciitis tends to develop gradually and tends to be worse in the morning and may improve throughout the day and with stretching exercises. Additionally, the pain is unlike the shooting and tingling pain associated with tarsal tunnel syndrome. A wide variety of conditions can cause pain in the foot or ankle including diabetes (diabetic neuropathy), posterior tibial tendinosis, stress fractures, certain rare disorders such as reflex sympathetic dystrophy and certain disorders that affect the nerves outside of the central nervous system (peripheral neuropathy). Diagnosis A diagnosis of tarsal tunnel syndrome is made based upon identification of characteristic symptoms, a detailed patient history, a thorough clinical evaluation and a variety of specialized tests. A specific finding that can detect an irritated nerve is Tinel’s sign. During a Tinel’s sign test, a doctor will tap or apply pressure to the tibial nerve. If this causes a tingling or a “pins and needles” sensation in the foot or toes, it is considered positive and is indicative of tarsal tunnel syndrome. Additional tests that may be performed include electromyography and magnetic resonance imaging (MRI). Electromyography is a test that can determine the health of muscles and nerves and can detect nerve dysfunction. An MRI uses a magnetic field and radio waves to produce cross-sectional images particular organs and bodily tissues and may be used if a space-occupying is the suspected cause of tarsal tunnel syndrome or to detect if the nerve is irritated.

Baxter’s nerve entrapment refers to an entrapment of the calcaneal branch of the posterior tibial nerve (Baxter’s nerve) . Baxter’s entrapment results in plantar heel pain. Baxter’s entrapment is typically unilateral but my be found bilaterally.  Baxter’s entrapment is most common in patients 25-50 years of age who are active in sports or in their occupation.  Surgical release of the nerve is the preferred method of care.

Plantar fascia release surgery involves cutting part of the plantar fascia ligament torelease tension and relieve inflammation of the ligament (plantar fasciitis). … The surgeon may detach the plantar fascia from the heel bone or make incisions on either side to release tension.

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