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Tarsal tunnel syndrome

Tarsal tunnel is the gap that is formed between the underlying bones of the foot and the overlying tough fibrous tissue. Tarsal tunnel syndrome refers to a condition where the posterior tibial nerve that lies within the tarsal tunnel is compressed. The condition occurs when the tibial nerve is pinched.

Exact cause of the condition is not known but certain conditions such as fractures, bone spurs, ganglions, benign tumours, muscle impingement, or foot deformities are known to increase the risk of developing tarsal tunnel syndrome. Other medical conditions such arthritis can cause swelling of the joints that may compress the nerve. Scar tissue formed after an ankle injury and growth of abnormal blood vessels can press against the nerve resulting in compression.

Most children with tarsal tunnel syndrome complain of pain, numbness, and burning or tingling sensation at the bottom of the foot and heel.

Tarsal tunnel syndrome can be diagnosed by Tinel’s test. Tinel’s test is performed by tapping the posterior tibial nerve lightly which produces pain and other symptoms indicating tarsal tunnel syndrome.

Tarsal tunnel syndrome may be treated with conservative approaches which include:

  • Non-steroidal anti-inflammatory medications to relieve pain and reduce swelling.
  • Corticosteroid injection that are injected into the area around the nerve to decrease the swelling.
  • Use orthotics, such as specially designed shoe inserts or change in foot wears will help to support the arch of the foot and take the tension off the tibial nerve.

Surgery is often considered a last resort only when conservative treatments fail to resolve the condition and provide symptomatic relief. Your doctor may perform tarsal tunnel release surgery to treat the condition. During this surgery an incision is made in the tarsal tunnel and the pressure on the tibial nerve is released.

High Arch (Cavus Foot)

High arch (cavus foot) is a condition in which the arch on the bottom of the foot that runs from the toes to the heel is raised more than normal. Because of this high arch, excessive weight falls on the ball and heel of the foot when walking or standing causing pain and instability. Children with neurological disorders or other conditions such as cerebral palsy, spina bifida, poliomyelitis, muscular dystrophy are more likely to develop cavus foot. It may sometimes occur as an inherited abnormality.

The symptoms of cavus foot include one or more of the following:

  • Pain in the foot while walking, standing and running
  • Heel is tilted inwards leading to instability of the foot and ankle sprains
  • Callus formation on the ball and at outer edges of the foot
  • Toes become bent (hammertoes) or clenched like a fist (claw toes)
  • Difficulty in wearing shoes
  • Foot length is shortened

Diagnosis of cavus foot is based on the family history and physical examination of the foot. X-ray of the feet may also be ordered to determine the condition.

Treatment

High arches that are flexible do not require any treatment. In cases where there is pain, shoe modifications such as an arch insert or support insole can help to relieve pain during walking. Custom orthotic devices can be given that fit into the shoe and provide stability and cushioning effect. Your doctor may recommend a brace to help keep the foot and ankle stable. In severe cases, surgery is performed to flatten the foot. Any coexisting nerve disorders are also treated.

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