Anterior Tarsal Tunnel Syndrome

Anterior tarsal tunnel syndrome is much like tarsal tunnel syndrome of the posterior tibial nerve. The nerve involved in the anterior tarsal tunnel is the deep peroneal nerve as it crosses over the front of the ankle joint.

Symptoms of anterior tarsal tunnel syndrome primarily are aching, cramping, or burning pain over the top of the foot. This sometimes extends as far as the space between the first and second toes. You may experience numbness in this area as well. Athletes are more commonly affected as repetitive compression of this area is seen with increased activity.

The cause for anterior tarsal tunnel syndrome can be due to anything causing compression of the nerve in its compartment. If relief of pressure is seen after removal of shoes or boots then the laces or tongue of the shoe may be the causative factor. Patients with previous trauma may have a bony exostosis present which allows for compression against the nerve with activity.

Prevention of anterior tarsal tunnel is usually aimed at controlling the structure of your foot as well as checking for external compressive forces in the shoes or boots you wear. The best prevention may be to get advice from your podiatrist.

Podiatric Care may include using anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce the swelling around the deep peroneal nerve. An injection may be used for both diagnosis and for treatment. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot and ankle to ensure no other bone problems exist. They may advise you on different shoewear or prescribe a custom made orthotic to try and control the foot structure especially if you have excessive pronation. Sometimes other examinations are needed to better understand the problem including an MRI, Electromygraphy (EMG), or a Nerve Conduction Study. Your podiatrist may send you to a neurologist to do these studies or evaluate you for other neuromuscular conditions. With positive test results and without relief using conservative care your podiatric physician may also recommend a surgical procedure to release the tarsal tunnel and decompress the nerve.

Surgery for release of an anterior tarsal tunnel is basically explorative. The tarsal tunnel is explored to release any compression from surrounding the nerve.

Post-operative Care and Risks with a decompression of the anterior tarsal tunnel is usually with a soft bandage and a post-operative shoe for protection. Weight bearing is usually allowed if tolerated. You should expect some pain following surgery as well as swelling. Especially for the first 48 hours you should keep your leg elevated and occasional ice placed over the area of surgery (about 20 minutes per hour). Surgical cuts are made through the skin so a scar is expected. If you are a keloid former, let your surgeon know. Surgical cuts are not only made through skin, but through other layers of tissue as well, a scar may form within your foot and lead to adhesions. Typically you can get back into a supportive tennis shoe in 3-5 weeks following healing of the wound and stitches are removed. You may use crutches, a walker, or wheelchair to help you keep weight off of this foot if needed for post-operative pain. Healing time is influenced by many factors including your nutrition, circulation, and other medical conditions. If you are a smoker you can expect to take longer to heal. If you are required to keep pressure off of your foot then your leg muscles are not being used as they were before surgery. This allows for slower movement of the blood through the leg vessels. Occasionally this can lead to a blood clot in the leg which can become life threatening. Hip and knee flexion and extension exercises as well as wiggling your toes gently can help prevent this from occurring. If you have a history of blood clots you should let your surgeon know. Any time surgery is done around a nerve the patient may experience a variety of feelings following surgery for several months, including some tingling, burning, and phantom pains. Some small nerve fibers may be released causing permanent numbness after surgery. With any nerve surgery there is a high incidence of reoccurrence of problems.