Tarsal Tunnel Syndrome When Conservative Management Has Not Worked
This protocol addresses tarsal tunnel syndrome in patients whose symptoms have persisted despite a full conservative treatment course and who have not reached the expected clinical targets.
Previous Treatment Line — Targets Not Achieved
Conservative line failedThe prior treatment course included activity modification, oral NSAIDs, orthotic shoes, nocturnal immobilisation brace, physiotherapy, and corticosteroid injection into the tarsal tunnel. Despite this, the following goals were not reached:
- Resolution of pain in the tarsal tunnel region
- Resolution of paraesthesia
- Resolution of burning and numbness in the foot
Next-Step Approach
When conservative measures fail to achieve symptom resolution, this protocol involves a surgical approach targeting nerve decompression within the tarsal tunnel. The full assessment criteria, patient selection, and procedural detail are contained in the complete regimen.
Treatment Goals
- Resolution of pain in the tarsal tunnel region
- Resolution of burning pain in the foot
- Negative Tinel's sign at the tarsal tunnel
- Resolution of sensory disturbance in the foot
- Resolution of muscle atrophy and weakness in the foot
References
DOI: 10.1016/j.jcot.2024.102489
- For patients who fail to show improvement after conservative treatment, surgical decompression may also be considered.
- Of the 32 included studies, all report use of surgical decompression of the posterior tibial nerve and its branches in the management of tarsal tunnel syndrome.
- The Takakura scale uses five domains including pain (spontaneous or on movement), burning pain, Tinel sign, sensory disturbance and muscle atrophy/weakness to assess outcome.
- The maximum score is 10, which is considered an excellent result and equivalent to a normal result, a score of 8 or 9 indicates a good results, 6 or 7 a fair result and five or below a poor outcome.