Foot Numbness from Tarsal Tunnel Syndrome: Understanding the Condition and How Advanced Surgical Techniques Can Help
By Dr. Oren Michaeli, DO – Board Certified General Surgeon, Fellowship-Trained in Hand Surgery, Microsurgery, and Peripheral Nerve Surgery
Introduction
Foot numbness is a frequent complaint among individuals suffering from lower extremity discomfort. While there are multiple potential causes, Tarsal Tunnel Syndrome (TTS) is a common yet often underdiagnosed reason for chronic foot numbness and pain. At Hand, Nerve & Microsurgery PC, I specialize in diagnosing and treating nerve-related conditions, including Tarsal Tunnel Syndrome. My approach involves a comprehensive surgical release—enhanced with stem cell therapy and intraoperative nerve stimulation—to promote expedited nerve regeneration and ensure lasting relief.
What Is Tarsal Tunnel Syndrome?
Tarsal Tunnel Syndrome arises when the posterior tibial nerve (or its branches) is compressed within the tarsal tunnel located near the inside of the ankle. The tarsal tunnel comprises the flexor retinaculum (a thick ligament) and underlying bone, forming a narrow passage for nerves, blood vessels, and tendons.
When inflammation, swelling, or any space-occupying lesion (e.g., ganglion cyst) develops in this area, the posterior tibial nerve experiences increased pressure. This compression often presents as tingling, burning pain, or numbness in the heel, arch, and sometimes the toes of the affected foot.
Common Symptoms
Distribution of pain, numbness or tingling in tarsal tunnel syndrome.
Numbness or Tingling: A “pins-and-needles” sensation along the underside of the foot or toes.
Burning or Shooting Pain: Patients frequently report localized pain near the ankle or extending into the arch.
Muscle Weakness: Chronic compression can impact foot muscle strength and endurance.
Activity-Related Aggravation: Prolonged standing or walking may worsen symptoms.
Radiation of Discomfort: Occasionally, pain may extend into the calf area due to interconnected nerve pathways.
Without timely intervention, these symptoms can progress to permanent nerve damage, underscoring the importance of early diagnosis and treatment.
Importance of Prompt Treatment
Prevent Further Nerve Injury: Early detection and management help avert irreversible nerve damage.
Restore Mobility and Comfort: Ongoing foot numbness and pain can significantly diminish quality of life.
Address Secondary Problems: Altered gait, ankle instability, or chronic inflammation can lead to additional musculoskeletal issues if left unresolved.
Diagnosis
Clinical Evaluation: A thorough physical exam, including palpation and provocative tests such as Tinel’s sign (light tapping over the nerve).
Imaging Studies: Ultrasound, MRI, or X-rays to identify potential structural abnormalities like bone spurs or cysts.
Electrodiagnostic Tests: Nerve conduction studies and EMG (electromyography) can help localize the exact site of compression and its severity. However at times electrodiagnostic studies can miss a tarsal tunnel syndrome. A patients story and a physical exam will be the most reliable predictors.
Treatment Options
Conservative Management: Orthotic support, footwear modifications, anti-inflammatory medications, and physical therapy may suffice for mild cases.
Surgical Tarsal Tunnel Release: For moderate to severe or refractory cases, surgical decompression is often the most definitive treatment. The procedure involves releasing the flexor retinaculum and relieving any structural pressures contributing to nerve entrapment.
Advanced Surgical Techniques: Stem Cell Therapy and Intraoperative Nerve Stimulation
Stem Cell Therapy:
Promotes Healing: Injecting stem cells around the site of nerve compression may accelerate tissue repair and reduce scarring. A nerve needs to slide and move freely without being tethered to a scar. By using your body’s own fat derived stem cells we increase your chances of success.
Enhanced Regeneration: Stem cells can create an optimal environment for nerve recovery by modulating inflammation and supporting healthy tissue growth.
Intraoperative Nerve Stimulation:
Boosts Nerve Recovery: Brief electrical stimulation has been shown to jump-start nerve healing, potentially leading to faster improvement in sensation and function.
Precision Care: This technique allows for a more tailored approach, ensuring complete decompression while enhancing post-surgical outcomes.
What to Expect During and After Surgery
Preoperative Preparation: Patients generally undergo a full evaluation, including blood tests and imaging, to confirm candidacy.
Anesthesia: Depending on the complexity of the case and patient preference, surgery may be performed under regional or general anesthesia.
Procedure: A careful incision is made along the inside of the ankle, where the flexor retinaculum is released, and any compressive lesions (such as cysts or varicosities) are addressed. In some patients they will undergo a fat harvest and processing to release stem cells. A biologic sheet of tissue is bathed in the solution and wrapped around the nerve and an intraoperative nerve stimulation lead is applied and the nerve is stimulated. The skin will be closed with suture.
Recovery: Postoperative protocols include gradual weight-bearing, activity modification, and possibly physical therapy to optimize healing and restore foot function. Recovery timelines vary, but patients some patients note significant improvement in numbness and pain in the weeks following surgery.
Why Choose Dr. Oren Michaeli at Hand, Nerve & Microsurgery PC
Specialized Expertise: As a fellowship-trained microsurgeon and peripheral nerve specialist, I possess the micro-level proficiency required to safely and effectively decompress delicate nerve structures in the foot.
Cutting-Edge Techniques: Combining stem cell therapy with intraoperative nerve stimulation often yields more rapid and robust nerve regeneration.
Patient-Centered Approach: Every patient is unique. I tailor each treatment plan to the individual, striving for the best clinical outcome and overall experience.
Comprehensive Aftercare: My team and I provide thorough postoperative guidance, ensuring consistent support from initial consultation to full recovery.
Contact Us for a Supportive, Patient-Focused Experience
If you’re experiencing persistent foot numbness, burning sensations, or other symptoms related to Tarsal Tunnel Syndrome, please reach out to schedule a comprehensive evaluation. We understand that navigating treatment options and insurance coverage can be overwhelming, and we are committed to providing a luxury patient-focused experiencewhere your comfort, well-being, and peace of mind are our top priorities.
Call us at (212) 540-4263 or email Info@handnervemicrosurgery.com to arrange a consultation at our office located at 570 Sylvan Ave, 2nd Floor, Englewood Cliffs, NJ 07632. For those who prefer an initial online consultation or have travel limitations, we also offer video consultations—allowing you to meet with us virtually from the comfort of your home.
We recognize that every patient’s insurance situation is different. In many cases, we can make arrangements for insurance to cover the operation even if we are not in your network. Our dedicated team will handle the administrative and logistical aspects of dealing with insurance companies, so you can focus on your recovery without the stress of unexpected financial burdens. Depending on your specific policy, this may even include coverage for travel and lodging, ensuring you receive first-rate medical care in a comforting environment.
Let us guide you through the process with compassion, expertise, and personalized care—helping you regain a pain-free, active lifestyle.
