Tarsal tunnel syndrome is often treated with surgery, especially when conservative treatment measures fail. Tarsal tunnel syndrome is a disease involving compression or inflammation of a major nerve that supplies sensation to the heel and bottom of the foot. This nerve runs through a tight fibrous space called the tarsal tunnel, which forms just under the inner side of the ankle. As this space becomes damaged, scarred, thickened, or tighter, the nerve becomes damaged and pain develops. As this worsens, the damage can become significant and chronic, and the pain can become severe. When conservative measures to reduce the inflammation fail, surgery is needed to relieve the pressure on the nerve.
In this surgery, an incision is made from the back of the ankle to the middle of the side of the foot, just past the ankle bone. The tissue that covers over the top of the tarsal tunnel is then released, and kept open to reduce the pressure. The nerve is then identified, and gently separated from the main artery and vein that accompanies the nerve in the tarsal tunnel. If there are any varicose areas of the vein noted in this space, these are removed because the enlarged vein branches often serve as a source of compression on the nerve. The nerve is then followed around the top of the ankle, and towards the foot, to ensure there is no further tissue compressing or tightening around the nerve in either direction. The nerve dives through a space between muscle tissue as it travels down under the foot, splitting into two branches. This space is inspected to ensure there is no further narrowing of the space, or abnormal enlargement of the muscle tissue.
Once there nerve is determined to be free, the overlying tissue is loosely repaired, and the skin is closed. A mildly compressive dressing is applied to avoid the surgical space from filling with fluid, and the foot is secured in a walking boot or surgical shoe to accommodate the dressing and stabilize the foot. The incision usually takes 2-3 weeks to heal. If proper rest and care is taken, it heals well. However, if proper rest is not taken the incision runs the risk of splitting open. Other potential complications include excessive scar tissue irritating the nerve space, infection, and moderate chronic swelling of the ankle. In general, though, this procedure provides effective relief of the pain tarsal tunnel syndrome causes, and allows the nerve to become healthy again.