Tarsal Tunnel Syndrome

The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (flexor retinaculum) that protects the structures contained within the tunnel—arteries, veins, tendons, and nerves.

Tarsal tunnel syndrome is a painful condition of the foot caused by pressure on the posterior tibial nerve as it passes along the tarsal tunnel just below the bony bit on the inside of the ankle. It produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot. It is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.

Tarsal tunnel syndrome is caused by anything that causes pressure on the posterior tibial nerve, including;

• An injury, such as an ankle sprain, which often produces swelling in or near the tunnel, results in nerve compression
• An enlarged or abnormal structure that occupies some of the space in the tunnel can cause pressure on the nerve. These include a ganglion, varicose veins and a bony spur.
• The outward tilting of a foot which is 'flat' can cause the tunnel to narrow and put pressure on the nerve
• Diseases such as diabetes or arthritis can cause swelling and compress the nerve

People who suffer with tarsal tunnel syndrome complain of tingling, burning, or a sensation similar to an electrical shock which is ,mainly felt on the inside of the ankle or the sole of the foot. Sometimes there is pain - usually a shooting pain which may extend to the heel and the toes and there can be numbness. The symptoms often appear very suddenly.
It is advisable to consult your podiatrist if you suffer from any of the symptoms of tarsal tunnel syndrome. It can be confused with other conditions and if left untreated it may cause unwanted and unnecessary permanent damage.

Treatment advice would always start with resting the affected foot. It promotes healing without causing further damage. If it is very painful or inflamed, applying an ice pack to the area may reduce swelling. Always put a thin towel between the ice pack and the skin. Your podiatrist may suggest some exercises for you to do and a biomechanical assessment may be necessary. The biomechanist may prescribe orthotic devices to be worn inside your shoes to reduce the nerve compression. Sometimes, immobilising the foot with a cast or walking boot, may be necessary.
The symptoms often subside very quickly, especially if the problem was caused by injury. As ever, don't suffer in silence...

The Footcare Clinic can help!

Posterior Tibial Dysfunction

People who suffer with Posterior Tibial Dysfunction often complain about a pain on the inside of the ankle, swelling in the area and often, they are unable to stand on their toes. This is more common in women over 40 years old, but it does happen to men too.

The posterior tibial tendon starts in the calf, passes down behind the inside of the ankle and attaches to bones in the middle of the foot. It provides support as you push off on your toes when walking. If this tendon becomes inflamed, or damaged, there is pain on the inner ankle and a gradual loss of the inner arch on the bottom of your foot, leading to flatfoot. This condition is also called 'Adult Acquired Flat Foot'. It is not hereditary but may be caused by an inherent abnormality of the tendon. Inflammation of the tendon may be caused  by excessive force on the foot, such as running uphill, or in sports where there is a rapid change of direction, for example football, hockey or tennis.

Those who are living with diabetes or inflammatory diseases such as rheumatoid arthritis are more likely to develop this condition, as is anyone with previous trauma to the foot. Obesity and pregnancy often put more pressure on the tendon and lead to inflammation.

An easy diagnostic exercise is to stand facing a wall. Support yourself against the wall and lift the unaffected foot out of

the way, whilst rising onto tiptoes of the other.  From behind, a companion will be able to see if the heel of the affected foot turns inward. If there is no inward rotation, then dysfunction of the posterior tibial tendon is indicated and a trip to your podiatrist is recommended.

Treatment of the disorder will involve orthotics, ranging from small shoe inserts to fixed ankle supports. Sometimes a walking boot is recommended.

Without treatment, the flatfoot that develops from posterior tibial tendon dysfunction eventually becomes rigid.  Pain increases and spreads to the outer side of the ankle and consequently, the way you walk may be affected causing pain in the hips knees and back.

If you think you may have this disorder, rest is recommended, especially reducing the amount of exercise which causes the pain. Utilise low impact exercise instead, such as swimming. Always warm up with stretches before exercising and using ice on the area can reduce inflammation. For specific advice on orthoses, a biomechanical assessment is recommended.

Please don't ignore this problem, it will get worse and your podiatrist can help you.

Charcot Foot

We are all aware that diabetes is a very serious condition. If you are in any doubt about the effects it can have, then look no further than Charcot foot.  

Diabetes, along with other conditions, can cause neuropathy which is a loss of the ability to feel temperature, pain and trauma. People with neuropathy, especially those who have had it for a long time, are at risk of developing Charcot foot. It is named after Jean-Martin Charcot, a French neurologist who in 1868 first associated neuropathy with bone and joint destruction in the foot.

The problem is due to the inability to ‘feel’ the ground as you walk, a lack of 'proprioception'. A good example of this is when walking on uneven ground. As the foot hits the ground, proprioceptors in the foot and leg recognise the position of the ground and adjustments are made in order to keep walking forward. When sensation in the feet is lost, the connection is not made between the feet and the brain; the feet do not adjust properly, causing excessive strain on the joints and bones. Over time these joints and bones begin to break down. The bones are weakened enough to fracture and with continued walking, the joints collapse and the foot takes on an abnormal shape.

The damage to the joints results in a foot that no longer functions properly. There are pressure points on the foot which may ulcerate and become infected which may in turn lead to osteomyelitis.

Nobody wants this to happen, so it is very important to understand the process and be able to recognise the symptoms.

The first stage is very destructive and the foot displays signs of inflammation; redness, swelling and increased heat. Under the surface the bones may be fractured, even though there is probably still no pain. Next, the body attempts to heal the fractured bones to restore normal joint function, but they are already damaged and with continued pressure from walking, they are deformed.

If Charcot's is treated early, the damage can be limited. Usually, a total contact cast is applied to the affected foot to evenly distribute the weight, although non-weightbearing is best. This prevents further damage and helps the bones to heal properly. If damage has occurred, then specialist footwear will help to minimise pressures on the foot and prevent ulcerations. Severely deformed feet may require surgery to remove bony prominences and to fuse weakened joints in order to prevent further damage.

SO VERY IMPORTANTLY:

• With diabetes, keep blood sugar levels under control to help reduce the progression of nerve damage in the feet.
• Check both feet every day. Charcot usually occurs in one foot, so if there is a difference between your feet, such as one is warmer and more swollen than the other, then contact your podiatrist or GP IMMEDIATELY
• Be careful to avoid injury, such as bumping the foot or overdoing an exercise program.
• Visit a podiatrist regularly.

Haglunds Deformity

What is Haglund's Deformity?

Haglund’s deformity is a bony enlargement or lump on the back of the heel bone (calcaneus), where the Achilles tendon attaches to the foot area. When that bony enlargement rubs against the heel counter of a shoe, the soft tissue near the Achilles tendon becomes inflamed, often leading to bursitis .

People suffering with Haglund's deformity complain of a rubbing pain which makes them limp when they put their foot to the floor, in shoes. They have a noticeable bump on the back of the heel, which is swollen and inflamed. It is relieved when walking barefoot.

The calcaneum, or the heel bone, is shaped differently on different people and those with a prominent bump are more likely to develop Haglund's deformity.

As with many foot disorders, Haglund’s deformity may be due to inherited foot structures. These  include

A prominent heel bump squeezing the tissues between the shoe counter and the heel.

A high-arched foot

A tight Achilles tendon

A tendency to walk on the outside of the heel.

Treatment of Haglund’s deformity is generally conservative, aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony protrusion. Your podiatrist will be able to advise on the best treatment options for you, but for immediate relief, ice may reduce the swelling of the inflamed area. Wearing shoes with modified heel counters or open-backed shoes will take pressure off the bump, as will walking barefoot.

Longer term, placing pads or cushions inside the heels of shoes can help take pressure off the back of the heel and orthotics may help to stabilise and control the motion of the foot. Some people find that wearing padded socks can also help take pressure off the back of the heel.

Whereas the bony protrusion will not change with conservative treatment, the thickened soft tissues may shrink back to normal size in time, once the pressure is removed.

Anyone who has suffered from Haglund's deformity will want to prevent it happening again. Logical steps to take include:

Wearing appropriate shoes - avoid shoes with a rigid heel back

Performing stretching exercises to prevent the Achilles tendon from tightening

Avoiding running on hard surfaces and running uphill  

Using orthotic devices as prescribed by your podiatrist

As ever, please don't suffer in silence. Call in to see us and ask for our help.