Tarsal tunnel syndrome (jogger's foot)

Entrapment of the tibial nerve in the foot between the medial malleolus and the ankle joint directly below an often thickened ligament (lacinatum ligament = Retinaculum flexorum).

Symptoms

Burning, painful altered sensation and a feeling of numbness in the sole of the foot and inside of the foot with tingling. Percussion of the ligament causes the altered sensation to radiate. Sometimes, the pain can also extend to the lower leg. In severe cases, atrophy (muscle loss) and weakness of the muscles of the inner foot can occur.

Possible causes: frequent injury, foot deformities, inflammations, obesity, tight or high footwear, excessive physical strain (runner's symptoms), misalignment, sprains, fractures, etc.

Treatment

In mild cases, simply taking pain-relieving or anti-inflammatory medication, the use of injections that include cortisone preparations, rest and physiotherapy are sufficient to relieve the symptoms of this condition.

If the symptoms last more than 6 weeks, or if the symptoms become unbearable, then surgical decompression is required. The procedure can be carried out under local anaesthetics or under general anaesthetics as an in-patient. A small skin incision below the medial malleolus is all that's required to expose the nerve and create more space by dividing the thickened ligament.

A protection time of 3 weeks is recommended post-operatively. Physiotherapy should then be commenced.