Huge Tts

Huge Tts




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Huge Tts
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Tarsal tunnel syndrome (TTS) occurs when you have tibial nerve damage. Your tibial nerve runs through your tarsal tunnel, a passage of bones and ligaments in your ankle. TTS symptoms may include pain, burning or tingling in the bottom of your feet and toes. Often, nonsurgical treatment decreases symptoms.


American College of Foot and Ankle Surgeons. Tarsal Tunnel Syndrome. (https://www.acfas.org/footankleinfo/tarsal-tunnel-syndrome.htm) Accessed 9/20/2021.
Kiel J, Kaiser K. Tarsal Tunnel Syndrome. (https://www.ncbi.nlm.nih.gov/books/NBK513273/) Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Accessed 9/20/2021.
National Organization for Rare Disorders. Tarsal Tunnel Syndrome. (https://rarediseases.org/rare-diseases/tarsal-tunnel-syndrome/) Accessed 9/20/2021.


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Tarsal tunnel syndrome (TTS) is a condition that occurs when you have a damaged or compressed tibial nerve. The tibial nerve is a nerve in your ankle. It runs through your tarsal tunnel, a passage in your ankle made up of bones and ligaments.
People who have TTS may have pain, tingling, numbness or weakness in their feet. You might develop TTS because of overuse of your foot and ankle. You’re more likely to develop TTS if you exercise strenuously or frequently, especially if you have a very flat foot.

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Experts don’t know exactly how many people have tarsal tunnel syndrome. Many people who have TTS don’t get a formal diagnosis. TTS can affect people of all ages.
Tarsal tunnel syndrome occurs when something damages your tibial nerve . Causes of tibial nerve damage can include:
For many people who develop tarsal tunnel syndrome, TTS is part of an overuse injury. More than 2 in 5 people with tarsal tunnel syndrome have a history of injuries such as ankle sprains. A sprained ankle is an injury to your ankle ligaments .
Tarsal tunnel syndrome causes signs of nerve pain. TTS usually causes pain in the inside of your ankle or the bottom of your feet. You may also experience:
Often, symptoms worsen during or after physical activity. If TTS is severe or long-lasting, you may experience symptoms all the time.
To diagnose tarsal tunnel syndrome, your healthcare provider will ask you to describe your symptoms. They may examine your ankle or look for injuries, as well.
Your healthcare provider may also use:
Many people can manage tarsal tunnel syndrome symptoms with at-home or over-the-counter treatments. You might try:
Your healthcare provider may also recommend nonsurgical treatments such as:
If TTS symptoms are still severe after trying nonsurgical treatments, your healthcare provider might recommend surgery. Operations are available that can release your tibial nerve or widen your tarsal tunnel. If a mass is putting pressure on your nerve, your surgeon will remove it.
There’s no guaranteed way to prevent tarsal tunnel syndrome. You can lower your risk of developing TTS if you:
Sometimes, symptoms go away after you treat the underlying cause of TTS. For example, if you have a bone spur or lipoma, symptoms may disappear after treatment.
Often, people manage TTS symptoms long-term. TTS is less likely to go away entirely if you have a chronic condition such as arthritis.
Without treatment, TTS can lead to nerve damage. If you develop nerve damage, it can be permanent and irreversible. You may have difficulty walking, exercising or performing your daily activities.
Thankfully, treatment can help you manage TTS symptoms. For the best results, it’s important to get treatment as soon as you start experiencing symptoms. Depending on the cause of TTS, treatment may even cure the condition.
You may want to ask your healthcare provider:
Some foot conditions have symptoms that are similar to TTS symptoms. A healthcare provider can offer an accurate diagnosis and treatment. These conditions include:
Tarsal tunnel syndrome is a condition that affects your foot and ankle. It occurs when your tibial nerve is damaged. Often, people develop TTS after overuse injuries. For many, nonsurgical treatment brings relief from tarsal tunnel syndrome. Your healthcare provider may recommend medications, steroid injections or custom orthotics. In severe cases, treatment might include surgery.
Last reviewed by a Cleveland Clinic medical professional on 09/20/2021.

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From Wikipedia, the free encyclopedia

^ Jump up to: a b c d e f g h Yates, Ben (2009). Merriman's Assessment of the Lower Limb (3rd ed.). New York: Churchill Livingstone. ISBN 978-0-08-045107-7 .

^ Baylan SP, Paik SW, Barnert AL, Ko KH, Yu J, Persellin RH (1981). "Prevalence of the tarsal tunnel syndrome in rheumatoid arthritis". Rheumatol Rehabil . 20 (3): 148–50. doi : 10.1093/rheumatology/20.3.148 . PMID 7280489 .

^ Mirick, Anika L., Gerald B. Bornstein, and Laura W. Bancroft. "Radiologic Case Study." Orthopedics 36.81 (2013): 154–57. Web. 22 Apr. 2014.

^ Dellon AL, Mackinnon SE, Seiler WA (1988). "Susceptibility of the diabetic nerve to chronic compression". Ann Plast Surg . 20 (2): 117–119. doi : 10.1097/00000637-198802000-00004 . PMID 3355055 .

^ Mackinnon SE, Dellon AL (1987). "Homologies between the tarsal and carpal tunnels: Implications for treatment of the tarsal tunnel syndrome". Contemp Orthop . 14 : 75–79.

^ Lee C, Dellon AL (2004). "Prognostic ability of Tinel sign in determining outcome for decompression surgery decompression surgery in diabetic and non-diabetic neuropathy". Ann Plast Surg . 53 (6): 523–27. doi : 10.1097/01.sap.0000141379.55618.87 . PMID 15602246 .

^ Beltran L. S.; Bencardino J.; Ghazikhanian V.; Beltran J. (2010). "Entrapment Neuropathies III: Lower Limb". Seminars in Musculoskeletal Radiology . 14 (5): 501–511. doi : 10.1055/s-0030-1268070 . PMID 21072728 .

^ "Usefulness of electrodiagnostic techniques in the evaluation of suspected tarsal tunnel syndrome: An evidence-based review" . aanem.org/getmedia/51417557-424c-4c29-be6a-5bbaff64517c/TarsalTunnel.pdf.aspx . Retrieved 15 February 2015 .

^ Ahmad, M. M., Tsang, K. K., Mackenney, P. J., & Adedapo, A. O. (2012). Tarsal tunnel syndrome: A literature review. Foot & Ankle Surgery (Elsevier Science), 18(3), 149–152.

^ Baylan, S. P., S. W. Paik, A. L. Barnert, K. H. Ko, J. Yu, and R. H. Persellin. "Prevalence Of The Tarsal Tunnel Syndrome In Rheumatoid Arthritis." Rheumatology 20.3 (1981): 148–150.

^ Jump up to: a b Low, Hu L., and George Stephenson. "These Boots Weren't Made for Walking: Tarsal Tunnel Syndrome." Canadian Medical Association Journal 176.10 (2007): 1415–416.

^ Gondring, William H., Elly Trepman, and Byron Shields. "Tarsal Tunnel Syndrome: Assessment of Treatment Outcome with an Anatomic Pain Intensity Scale."Foot and Ankle Surgery 15.3 (2009): 133–38.

^ Bracilovic, A., A. Nihal, V. L. Houston, A. C. Beatle, Z. S. Rosenberg, and E. Trepman. "Effect of Foot and Ankle Position on Tarsal Tunnel Compartment Volume." Foot and Ankle International 27.6 (2006): 421–37.

^ Nakasa, Tomoyuki, Kohei Fukuhara, Nobuo Adachi, and Mitsuo Ochi. "Painful Os Intermetatarseum in Athletes: Report of Four Cases and Review of the Literature." Archives of Orthopaedic and Trauma Surgery 127.4 (2007): 261–64. Print.

^ Kavlak Y, Uygur F (2011). "Effects of nerve mobilization exercise as an adjunct to the conservative treatment for patients with tarsal tunnel syndrome". J Manipulative Physiol Ther . 34 (7): 441–8. doi : 10.1016/j.jmpt.2011.05.017 . PMID 21875518 .

^ Gondring WH1, Trepman E, Shields B. (2008). Tarsal tunnel syndrome: assessment of treatment outcome with an anatomic pain intensity scale. Foot Ankle Surg. 15(3):133-8

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Diseases relating to the peripheral nervous system
Tarsal tunnel syndrome ( TTS ) is a compression neuropathy and painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel . [1] This tunnel is found along the inner leg behind the medial malleolus (bump on the inside of the ankle). The posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles travel in a bundle through the tarsal tunnel. Inside the tunnel, the nerve splits into three segments. One nerve (calcaneal) continues to the heel, the other two (medial and lateral plantar nerves) continue on to the bottom of the foot. The tarsal tunnel is delineated by bone on the inside and the flexor retinaculum on the outside.

Patients with TTS typically complain of numbness in the foot radiating to the big toe and the first three toes, pain , burning, electrical sensations, and tingling over the base of the foot and the heel. [1] Depending on the area of entrapment, other areas can be affected. If the entrapment is high, the entire foot can be affected as varying branches of the tibial nerve can become involved. Ankle pain is also present in patients who have high level entrapments. Inflammation or swelling can occur within this tunnel for a number of reasons. The flexor retinaculum has a limited ability to stretch, so increased pressure will eventually cause compression on the nerve within the tunnel. As pressure increases on the nerves, the blood flow decreases. [1] Nerves respond with altered sensations like tingling and numbness. Fluid collects in the foot when standing and walking and this makes the condition worse. As small muscles lose their nerve supply they can create a cramping feeling.

Tinel's sign is a tingling electric shock sensation that occurs when you tap over an affected nerve. The sensation usually travels into the foot but can also travel up the inner leg as well.

It is difficult to determine the exact cause of tarsal tunnel syndrome. It is important to attempt to determine the source of the problem. Treatment and the potential outcome of the treatment may depend on the cause. Anything that creates pressure in the tarsal tunnel can cause TTS. This would include benign tumors or cysts, bone spurs, inflammation of the tendon sheath, nerve ganglions, or swelling from a broken or sprained ankle. Varicose veins (that may or may not be visible) can also cause compression of the nerve. TTS is more common in athletes and other active people. These people put more stress on the tarsal tunnel area. Flat feet may cause an increase in pressure in the tunnel region and this can cause nerve compression. Those with lower back problems may have symptoms. Back problems with the L4, L5 and S1 regions are suspect and might suggest a "Double Crush" issue: one "crush" (nerve pinch or entrapment) in the lower back, and the second in the tunnel area. In some cases, TTS can simply be idiopathic. [1]

Rheumatoid Arthritis has also been associated with TTS. [2]

Neurofibromatosis can also cause TTS. This is a disease that results in the formation of pigmented, cutaneous neurofibromas. These masses, in a specific case, were shown to have the ability to invade the tarsal tunnel causing pressure, therefore resulting in TTS. [3]

Diabetes makes the peripheral nerve susceptible to nerve compression, as part of the double crush hypothesis. [4] In contrast to carpal tunnel syndrome due to one tunnel at the wrist for the median nerve, there are four tunnels in the medial ankle for tarsal tunnel s syndrome. [5] If there is a positive Tinel sign when you tap over the inside of the ankle, such that tingling is felt into the foot, then there is an 80% chance that decompressing the tarsal tunnel will relieve the symptoms of pain and numbness in a diabetic with tarsal tunnel syndrome. [6]

Anything compromising the tunnel of the posterior tibial nerve proves significant in the risk of causing TTS. Neuropathy can occur in the lower limb through many modalities, some of which include obesity and inflammation around the joints. By association, this includes risk factors such as RA, compressed shoes, pregnancy, diabetes and thyroid diseases [7]

Diagnosis is based upon physical examination findings. Patients' pain history and a positive Tinel's sign are the first steps in evaluating the possibility of tarsal tunnel syndrome. X-ray can rule out fracture. MRI can assess for space occupying lesions or other causes of nerve compression. Ultrasound can assess for synovitis or ganglia. Nerve conduction studies alone are not, but they may be used to confirm the suspected clinical diagnosis. Common causes include trauma, varicose veins , neuropathy and space-occupying anomalies within the tarsal tunnel. Tarsal tunnel syndrome is also known to affect both athletes and individuals that stand a lot. [1]

A neurologist or a physiatrist usually administers nerve conduction tests or supervises a trained technologist. During this test, electrodes are placed at various spots along the nerves in the legs and feet. Both sensory and motor nerves are tested at different locations. Electrical impulses are sent through the nerve and the speed and intensity at which they travel is measured. If there is compression in the tunnel, this can be confirmed and pinpointed with this test. Some doctors do not feel that this test is necessarily a reliable way to rule out TTS. [1] Some research indicates that nerve conduction tests will be normal in at least 50% of the cases.

Given the unclear role of electrodiagnostics in the diagnosis of tarsal tunnel syndrome, efforts have been made in the medical literature to determine which nerve conduction studies are most sensitive
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