Crushing the Double Crush

This patient is now nearly two months out from a decompression of the Proximal Tibial Nerve at the soleal sling in the calf that was performed in order to try to improve upon her residual symptoms of numbness, tingling, buzzing, and pain in the sole of the foot after a previous tarsal tunnel release with decompression of the medial plantar, lateral plantar, and calcaneal nerves had been performed at the ankle and foot. The release of the tarsal tunnel and its downstream branches provided her about 50% relief of her original symptoms. While 50% relief of one’s numbness and tingling is better than living with what she previously presented with, she continued to demonstrate physical findings and complaints up in the back of the calf that indicated that the tibial nerve “upstream” may also be compressed. We call this a “double crush.” This means that she had the tibial nerve compressed in the ankle as the “first” crush and the proximal tibial nerve in the calf about 18 inches higher up the leg as the second “crush.”

What symptoms did she have that suggested this upstream compression? She had severe pain in the back of the calf with walking, persistent numbness and tingling in the entire sole of the foot, perhaps a trace of weakness in great toe flexion (some people are very weak in the great toe), AND she NO longer had a “Tinel” sign (feeling of a “funny bone” running down the foot) when we tapped at the tarsal tunnel in the inner heel. Her “Tinel” sign had disappeared because we had decompressed that area, releasing the nerve, and it had been recovering for 6 months. Her clinical findings, her persistent complaints both point to a possible problem up in the calf compressing the tibial nerve upstream.

She presents back to the office about 6 weeks after surgery with nearly 100% improvement in the pain in the back of the calf, and the sensation and pain in the sole of the foot!

We could not be more excited for her! The foot is ticklish again!

This is what we call conquering the “Double Crush.”

If you or someone you know has had a previous tarsal tunnel release and are still having symptoms and are not happy as you would like to be with the outcome, we would be happy to see and examine you for a compression of the nerve upstream, while also determining if the tarsal tunnel release was performed adequately to begin with.

Feel free to reach out to us if you are having problems or would like an evaluation by filling out a contact form here or by calling