Tarsal Tunnel Self Exam Demonstration

This is Dr. Williams and today I wanted to talk a little bit about tarsal tunnel syndrome and how we can help ourselves make a diagnosis, and how can a patient potentially examine themselves at home. Although sometimes it doesn't work and therefore you have to come see us actually in person. Tarsal tunnel syndrome is like carpal tunnel syndrome, most people have heard of that this is a nerve compression in the hand, but tarsal tunnel syndrome is a nerve compression in the inner ankle. The tibial nerve in the inner ankle goes to the sole of the foot and it goes to the heel, and the arch, and the ball of the foot, and the entire sole of the foot, both inside to the big toe and outside of the fifth toe. The patients who have tarsal tunnel syndrome frequently will complain of numbness, tingling, buzzing, burning, hypersensitivity, or just pain in one part are all of the sole of the foot. So it could be the heel it, could be the ball the foot, it could be a half of your foot any one of those branches that branches off the tibial nerve can be pinched and those branches include the calcaneal branch which goes to the heel, the medial plantar nerve that goes to the big toe, and second toe, and third toe, and then the lateral plantar nerve that goes to the fourth and fifth toe. So one or all of those branches can be pinched leading to symptoms in the sole of your foot. 

One of the things that we look for, it's not the only sign and is certainly not fail proof but it is very helpful, this is called the Tinel sign or Hoffman-Tinel sign. And that's the quote “funny bone” feeling you get when you hit your elbow and it shoots into your little finger. you can get that on any nerve that seems to be compressed or injured and so where we check that is we check that on the inside of your ankle so I’ll show you here in a second where that is and how you might be able to do that at home. 
But that is a pretty good indicator it's not fail proof but it is very helpful. Patients who have these tingling sensations they can test themselves and if it's really strong or if it's present at all this may be an indicator a good indicator that you may have a pinched nerve that's actually causing your heel pain, or your arch pain, or your foot pain. So we'll break here and I’ll show you how to do that. 

So this is a little bit difficult doing on yourself but, excuse my feet, we're on the inside of my ankle here, this is called the medial malleolus this is the little bone that sticks up in the air that you're looking straight up in the air when you cross your foot. Here’s my Achilles tendon right here and here's my heel. And so this tibial nerve will travel right down in between the medial malleolus and the Achilles tendon, and so it will travel right here and go into your foot. 

So what I encourage patients to try to do, if they're trying to do this on themselves, is to use their index finger and their middle finger make a strong force and then I would recommend that they bring their ankle not pointing down but bring their ankle upward, it puts tension here and flattens it out like a trampoline, okay? And then you can use your fingers and you can tap just behind the bone, just in front of the Achilles tendon, you can tap right here and you can then take it down slightly and into the arch. And usually somewhere in this region, if you have these symptoms and if this nerve is pinched, you can get a tingling boom, an explosion of electricity down into the heel or into the arch of the foot or into the medial foot or the outer foot. And so again you want to tap, how hard do you tap? I always tell patients with a little bit of love, maybe a lot of love, but no passion okay. So you're not trying to beat yourself to death you're trying to provide enough force as if you're trying to knock on a bathroom door of someone who's in there but not that you're angry at them okay. So you're trying to tap on it I can make anyone hurt if I tap hard enough we're looking for physiologic pressure okay so we're looking for pressure that's not super human, we don't want to be superman when we do this.  We want to see if you get a just an electric tingle right down your foot okay? So it's right in this area in your heel and you can start right here right at the bone and you can go into the arch of your foot. And you can experiment with a little extra pressure but you want to thump it with a good solid thump, you don't want to be limp wristed, okay? You want to be able to hear the noise.