North Central Office
540 Madison Oak,
San Antonio, TX 78258
(Stone Oak Medical Office Bld. at North Central Baptist Hospital)
Live Oak Office
12413 Judson Rd., Suite 250
Live Oak, TX 78233
TARSAL TUNNEL SYNDROME
Heel Pain Caused by Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is one of the more common of the less common causes of heel pain. The posterior tibial nerve is the main nerve to the bottom of the foot, its fibers taking origin from nerve roots L5, S1. The posterior tibial nerve travels through a canal along the inside of the ankle on its way to the sole of the foot. It is most likely to become squeezed or entrapped in that canal, the canal also being known as the tarsal tunnel.
The posterior tibial nerve has two main branches that give sensation to the bottom of the foot, the medial plantar nerve and the lateral plantar nerve. There are some small branches given off from the posterior tibial nerve before it splits into its main two branches known as the medial calcaneal nerves. Uncommonly, the medial calcaneal nerves themselves can become entrapped causing pain right on the bottom of the heel.
The first branch that comes off the lateral plantar nerve is sometimes called "Baxters nerve" and can become entrapped by itself, causing pain at the base of the heel. This is termed "Baxter's neuritis" and its existence is somewhat controversial and unproven.
Pressure or entrapment of the posterior tibial nerve (tarsal tunnel syndrome) can be caused by scar tissue or by "growths" pressing up against the nerve. It has been estimated that as many as 30% of such growths include varicose veins in the tarsal tunnel. Other "growths" may include ganglions (fluid filled cysts) or other tumors, but rarely maligancies.
Testing for tarsal tunnel syndrome often includes an NCV, nerve conduction velocity test. If tarsal tunnel syndrome is found, an MRI may be ordered to look for the existence of a growth which may be pressing up against the nerve.