Tarsal tunnel syndrome

by Lynne
(Cincinnati, Ohio)

Hi, Dr. Mitnick,

I wrote to you several months ago about the tingling in my feet following a broken right hip and then a fractured great toe that happened in physical therapy the first day I was allowed to bear weight. I was nonweight bearing on my right leg for 10 weeks. I am only 51 years old. I had a cell phone vibration in the bottom of both feet with the right one being much worse. I saw a podiatrist, had an EMG and nerve conduction studies on both legs and feet and was diagnosed with tarsal tunnel syndrome of the right foot just as you had thought it was. I was casted for new orthotics as my old ones were not right for my feet. I immediately felt a decrease in foot vibrations upon wearing them but I still have some tingling. Are there any exercises or anything else I can do to help this? I am to return to the podiatrist in two weeks from starting the new orthotics. Besides extremely flat feet that pronate, I also was told I have pronounced arthritis in my mid foot regions and accessory navicular in both feet which contributes to their flatness. Thank you for any suggestions that may make me not have to have surgery. Gratefully, Lynne

RESPONSE

Hi Lynne,

The first thought that comes to mind is to give your situation some more time. Think about it. If you have a nerve entrapment as a result of your feet flattening out and putting pressure on the nerve, just by getting into an orthotic your symptoms should improve, but probably slowly. The tibial nerve is inflamed from the excess pressure, you have now removed the pressure but it takes time for the inflammation to subside.

An analogy would be an ankle sprain, you fall and twist your ankle, the ankle hurts and even though you are no longer falling, the ankle still hurts, but, gradually gets better until there is no pain.

I would suggest to you that by continual wear of your orthotics your symptoms, in theory at least should improve. Keep in mind, most people do not wear their orthotics all day long, so for example, if you come home at dinner time and kick off your shoes, you are then walking around for the next few hours pronated and re-aggravating your tarsal tunnel.

There is also a possibility that you may be able to tolerate more support than you have in your orthotics. More support, means less nerve irritation. Let your podiatrist decide on that.

Keep in mind that excess pronation is probably the most common cause of tarsal tunnel but not the only. Another cause could be a growth of some sort in the tarsal canal which will also put pressure on the nerve.

I mention this because if you do not fully improve I would recommend an MRI of the tarsal tunnel canal to look for any abnormality which might explain why you still have issues.

Short of that, if after a period of time wearing your orthotics still gives you only moderate relief, speak to your podiatrist about a possible cortisone injection into the tarsal tunnel canal or even a round of oral prednisone.

I also think your podiatrist has to take into account any residual effects from your right hip surgery as that may be affecting your gait as well.

At age 51 the arthritis in your midfoot is the result of being pronated, it is not the cause or precipitating factor in pronation. The accessory navicular may or may not be a precipitating factor in your flat feet.

Marc Mitnick DPM
DISCLAIMER