Nevralgia tibial posterior

A nevralgia tibial posterior é a dor no tornozelo, pé e dedos do pé, causada pela compressão ou lesão do nervo que chega ao calcanhar e à planta do pé (nervo tibial posterior).

Este nervo percorre a face posterior da barriga da perna, atravessa um canal ósseo perto do calcanhar e chega até à planta do pé. Quando os tecidos circundantes deste nervo ficam inflamados, podem comprimi-lo, causando a dor.

A dor, o sintoma mais frequente desta afecção, apresenta-se como um ardor ou um formigueiro. Pode aparecer quando a pessoa está de pé, a andar, ou quando usa um tipo particular de calçado. A dor, habitualmente localizada à volta do tornozelo e espalhada aos dedos do pé, piora ao andar e atenua-se com o repouso. Algumas vezes, a dor também aparece durante o repouso.

Para diagnosticar esta afecção, o médico move o pé durante o exame físico. Por exemplo, dá pancadas suaves na zona que estiver lesada ou comprimida, o que com frequência causa um formigueiro que pode estender-se ao calcanhar, ao arco do pé, ou aos dedos. Podem ser necessários exames adicionais para determinar a causa da lesão, especialmente se estiver a ser considerada uma intervenção cirúrgica no pé.

As injecções de uma mistura de corticosteróides e anestésicos locais na zona podem aliviar a dor. Outros tratamentos consistem em ligar o pé e colocar dispositivos especialmente desenhados no calçado para reduzir a pressão sobre o nervo. Quando os outros tratamentos não aliviam a dor, a cirurgia pode ser necessária para aliviar a pressão no nervo.

What is Tarsal Tunnel Syndrome?

Tarsal Tunnel Syndrome (TTS) is known as a compression neuropathy (nerve disorder due to squeezing of the nerve) in the ankle and foot. It is similar to Carpal Tunnel Syndrome, which occurs in your wrist, however far less common. In Latin, tarsal means ankle, therefore Tarsal Tunnel Syndrome results from compression or damage to the posterior tibial nerve located in your tarsal canal, which runs through the small space along the inside of your ankle into the heel and sole of your foot. It causes a lot of pain in your foot, ankle and toes. This condition is slowly progressive and occurs more commonly after 30 - 40 years of age.

Often damage to your posterior tibial nerve in one location may affect the overall functioning of your nerve, so you are more at risk of suffering from compression in other areas along the nerve. The nerve sends signals along its length and also moves its own nutrients, which is necessary for optimal function. Nutrients move along the entire length of your nerve via axoplasms (jelly-like material that fills the cells of the axons). If the flow of these nutrients is blocked, your nerve tissue further from the area of compression does not receive the essential nutrients to fight off injuries, and your damage will get worse.

Other names and/or similar conditions:

• Tarsal Tunnel Neuropathy
• Entrapment Neuropathy Of The Tibial Nerve
• Posterior Tibial Neuropathy
• Compression Of The Tibial Nerve
• Posterior Tibial Neuralgia

Tarsal Tunnel Syndrome Anatomy

The tarsal tunnel is found between the thick, overlying fibrous tissue on one side of your foot and the underlying bones on your other side. The flexor retinaculum acts as the top of your tarsal tunnel. It forms a deep, band of fibrous connective tissue that surrounds the muscles and nerves in your lower leg and ankle. The top of the Calcaneus (largest tarsal bone that makes up the heel), the inner wall of the Talus (2nd largest tarsal bone that forms the ankle joint connecting the leg bones to the foot bones) and the inner/bottom part of the Tibia (shinbone) comprise the bottom of your tarsal tunnel. Your ankle and foot tendons, muscles, nerve, artery and vein pass through the Tarsal Tunnel to get to the bottom of your foot.

Your Posterior Tibial Nerve is found between the Posterior Tibial Muscle, the Flexor Digitorum Longus and the Flexor Hallucis Longus muscles in your lower leg/ankle. The Tibial Nerve moves behind the bump on the inside of your ankle (Medial Malleolus) and through the Tarsal Tunnel, where it then divides into nerve branches in the sole of your foot.

Symptoms of Tarsal Tunnel Syndrome

Although they vary from person to person, most of these symptoms are generally experienced on either the inside of the ankle and/or the bottom of the foot. The most common symptoms noted by those who suffer from Tarsal Tunnel Syndrome are:

• Tingling, burning, or prickling sensation (also known as paresthesias), in your foot (often in your arch, toe or heal).
• Vague or sharp pain, near the area where the nerve is squeezed (often in the sole of your foot, near your big toe, or along your nerve); this pain tends to be worse at night.
• Numbness, a loss of sensation in the area of skin that is supplied by the nerve.
• Atrophied (weakened) muscles in your inner foot (around the ball or arch of your foot) can affect your gait (the way you walk). You may have a tendency to overpronate (your foot rolls in too much), limp or feel uncoordinated as a result of too much pressure being placed on your foot.
• A lower foot deformity (like flat feet) can increase tension in the foot and may instigate the symptoms of TTS.

You can feel these symptoms on their own in one location or in various locations across your foot and lower leg. They can be aggravated by overuse of your foot through walking, exercising or prolonged standing. These symptoms will often subside with rest however they will not disappear.

If left untreated, you are at risk of suffering from permanent nerve damage.

Treating Tarsal Tunnel Syndrome

Freezie Wrap™ Cold Compression Therapy

When treating Tarsal Tunnel Syndrome, rest the area as much as possible, apply ice for 10-20 minutes at a time for at least 3 times a day. Do this to the injured area for the first day to 3 days. The importance of blood flow stimulation and cold compression treatment is very high, though when surveyed, most TTS sufferers never take advantage of either of this easy treatments. Ice will reduce initial inflammation and swelling and the heat circulates blood through the area to speed the healing process. This can be further helped by the use of ultrasound applications over the affected area, as it reduces swelling quickly and increases blood flow to the area.

Inferno Wrap™ Blood Flow Stimulation Therapy

An Inferno Wrap for the ankle or bottom of the foot is one of the most helpful tools for painful foot related problems. Through the absorption of special energy waves, tissues are safely and gently heated - increasing blood flow within the treated area. Your body's natural response to this increased temperature is to try to maintain a condition of homeostasis - a balanced environment or state of equilibrium throughout the body. To do this, your body responds with a rapid increase in blood flow to the area (this is known as vasodilation), increasing the supply of nutrients to injured cells and flushing out toxins (including lactic acid, commonly found in trigger points) to promote healing. Our Plantar/Spur or Ankle Inferno Wrap provides effective, non-invasive, non-addictive pain relief with no side effects.

MendMeShop Ultrasound Therapy

The long term use of therapeutic ultrasound is common with this injury, as the application of ultrasound will:

Counteract atrophy in muscles and tendons.

Increase the elasticity of all tendons that pass through the tarsal tunnel.

Soften inelastic scar tissue from injured tendons / muscle fiber to the point where it is eventually re-absorbed by the body.

Decrease inflammation of tendons, and the flexor retinaculum (a fibrous sheath passing through the tarsal tunnel). All tendons in the tarsal tunnel are sheathed, and once tendons become inflamed, the sheath swells and can also become inflamed, and at the worst, infected. If you suspect you have any type of infection in the area, please consult a physician immediately as this can be very damaging if left untreated. (Never use ultrasound over anything suspected of being infected.)

Changes in footwear and orthotic arch supports, along with calf and foot stretching exercises have also been known to provide relief for individuals with chronic TTS.

A Final Word About Therapeutic Ultrasound

It is important to know that therapeutic ultrasound will alleviate TTS symptoms, but to truly treat TTS properly and prevent reoccurrence, an extended treatment term is required - 2 months is not unusual. Treatment length will vary depending on the severity, and there are some cases of TTS that are just too chronic, in which case there are very few treatment options other than invasive surgery. If this is the case for your TTS condition, please make sure you are fully informed about the risks and rewards of TTS corrective surgery.

 

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