Tarsal Tunnel Syndrome Condition
This is a rare syndrome that is hard to diagnose and treat. Finding a physician that specializes in foot and ankle disorders is absolutely essential. Tenderness and or tingling are usually found over the posterior tibial nerve.
The most definitive diagnostic tool is a skilled and experienced physician using a nerve conduction study across the tarsal tunnel. This test is not infallible and some false negative results are seen. If the hindfoot is in valgus (pronated) diagnosis should be re-checked. This being said, the point of whether the rear foot is pronated or supinated in tarsal tunnel syndrome is somewhat controversial. Many excellent reviews of tarsal tunnel syndrome suggest that it is due to a pronated hind foot. According to this theory, the posterior tibial nerve is stretched by a pronated hind foot as is goes around the foot. This makes intuitive sense. However during a study by Dr. Mark A. Riley, M.D. (one of the Orthopedic Specialty Physicians for the University of California, Berkeley, Health Services, and has been the Chief Orthopedic Consultant for the Adult Hemophilia Clinic at Bates Hospital in Berkeley), all the patients with tarsal tunnel syndrome that were treated with a varus post, (medial posting to reduce pronation) all became worse or were no better. It was concluded that in a supinated foot the posterior tibial nerve is impinged upon producing pain. A custom molded biomechanical orthotic with lateral posting to put the foot into a pronated position opens up space and may provide relief. It is because of these different opinions that we strongly advise patients to seek the advice of a skilled and experienced physician for an accurate diagnosis.