■ ■ ■ Description

Anterior tarsal tunnel syndrome is a nerve disorder in the foot and ankle that causes pain and loss of feeling, often in the foot between the first and second toes or the upper outer foot by the ankle. It involves compression of the deep peroneal nerve at the front of the ankle by ligament-like tissues (retinaculum) or other structures.

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■ ■ ■ Common Signs and Symptoms

• Tingling, numbness, or burning in the foot between the first and second toes and occasionally in the upper outer foot by the ankle

• Pain and discomfort at the ankle and top of the foot, occasionally radiating to the upper outer foot (near the ankle), and between the first and second toes

• Pain, usually with sports activities, and often felt at night; relieved by removing shoes and resting

• Possibly, weakness in extending the toes

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■ ■ ■ Causes

Pressure on the deep peroneal nerve at the ankle caused by ligament-like tissue that covers and pinches the nerve or by bone spurs, ganglion cysts, inflammation, or direct injury (from kicking or even from keys placed in the laces of jogging shoes)

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■ ■ ■ Risk Increases With

• Sports that require repeated, forceful extension of the ankle (such as sprinting, jumping)

• Repeated injuries to the foot or ankle

• Poor physical conditioning (strength and flexibility)

• Inadequate warm-up before practice or competition

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■ ■ ■ Preventive Measures

• Appropriately warm up and stretch before practice or competition.

• Maintain appropriate conditioning:

• Foot and ankle flexibility

• Muscle strength and endurance

• Cardiovascular fitness

• Ensure proper equipment (shoe) fit

• Taping, protective strapping, bracing, or high-top tennis shoes may help prevent ankle sprains and nerve-stretching injury.

• Do not tie keys to shoelaces.

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■ ■ ■ Expected Outcome

Usually curable with appropriate treatment, although resolution may occur spontaneously. Occasionally, surgery is necessary.

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■ ■ ■ Possible Complications

• Permanent numbness and weak toes in the affected foot

• Persistent pain in the foot or ankle

• Inability to compete due to pain

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■ ■ ■ General Treatment Considerations

Initial treatment consists of rest from the offending activity and medications and ice to help reduce inflammation and pain. Padding (moleskin) in the shoe to reduce pressure on the nerve may be beneficial. Changing the lacing pattern of the shoe may also alleviate the symptoms. Stretching and strengthening exercises of the muscles of the foot and ankle can be useful. Chronic cases often require referral to a physical therapist or an athletic trainer. If this treatment is not successful, surgery may be necessary to free the pinched nerve. Surgery may be performed as an outpatient procedure (you go home the same day) to remove the source of compression (bone spurs, ganglion cysts, inflamed retinacular tissue). This provides almost complete relief in most patients.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers may be prescribed as necessary by your physician, usually only after surgery. Use only as directed and only as much as you need.

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■ ■ ■ Heat and Cold

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 2 weeks despite treatment 

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)