Over Use Syndromes

Hand & Wrist

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome is a common, painful, progressive condition that is caused by compression of the median nerve at the wrist area. Common symptoms of carpal tunnel syndrome include numbness and tingling sensation in all the fingers except little finger; pain and burning sensation in hand and wrist that may radiate up the arm and elbow; and weakness in hand with diminished grip strength. Although exact cause for the condition remains unknown certain factors increase the risk of developing carpal tunnel syndrome and they include congenital abnormalities, repetitive motion of hand and wrists, fractures and sprains, hormonal imbalance, and other medical conditions such as hypothyroidism, rheumatoid arthritis, diabetes, obesity, gout, overactive pituitary gland, or the presence of a cyst or tumor in the canal.

Carpal tunnel syndrome may be treated using conservative approaches or surgery. The conservative treatments include:

• Treating underlying medical conditions
• Immobilization of the hand and wrist with a splint or wrist brace for 4-6 weeks
• Rest the hand for 2 weeks or more
• Ice packs to avoid swelling
• Avoid activities that tend to worsen the symptoms
• Medications such as non-steroidal anti-inflammatory drugs, diuretics, and steroid injections.
• Strengthening and stretching exercises once symptoms diminish

If conservative treatment options fail to resolve the condition your surgeon may recommend surgical procedure.

Carpal Tunnel Release Surgery

Carpal tunnel syndrome can be treated with carpal tunnel release Surgery. Surgeon makes a 2- inch incision in the palm and wrist area. Then the transverse carpal ligament will be dissected to release the pressure on the median nerve and enlarge the carpal tunnel. After the ligament is cut, the incision is closed with sutures and covered with a sterile dressing.
Your surgeon may suggest you to practice certain post-operative procedures for better recovery and to avoid further complications.

• Elevate the hand above heart level to reduce swelling
• A splint may be worn
• Ice packs to the surgical area to reduce swelling\
• Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering
• Physical therapy may be ordered to restore wrist strength
• Eating a healthy diet and not smoking will promote healing

The majority of patients suffer no complications following carpal tunnel release surgery. However some patients may suffer from pain, infections, scarring, and nerve damage causing weakness, paralysis, or loss of sensation and stiffness in the hand and wrist area.

Elbow

Tennis Elbow

Tennis elbow is the common name for the elbow condition lateral epicondylitis. It is an overuse injury that causes inflammation of the tendons that attach to the bony prominence on the outside of the elbow. It is a painful condition occurring from repeated muscle contractions in the forearm that leads to inflammation and microtears in the tendons that attach to the lateral epicondyle. The lateral epicondyle is the bony prominence that is felt on the outside of the elbow and the condition is more common in sports individuals playing tennis.

Patients with tennis elbow experience certain symptoms and they include:

• Elbow pain that gradually worsens
• Pain to the outside of the elbow that radiates to the forearm and wrist with grasping objects
• Weak grip
• Painful grip
• Pain is exacerbated in the elbow when the wrist is bent back

Tennis Elbow is usually caused by overuse of the forearm muscles but may also be caused by direct trauma such as with a fall, car accident, or work injury.

Tennis elbow is commonly seen in tennis players, hence the name, especially when poor technique is used when hitting the ball with a backhand stroke. Other common causes include any activity that requires repetitive motion of the forearm such as:

• Painting
• Hammering
• Typing
• Raking
• Weaving
• Gardening
• Lifting heavy objects
• Playing musical instruments

Your physician will evaluate tennis elbow by,

• Medical History
• Physical Examination
• Diagnostic procedures such as X-rays

Your physician will recommend conservative treatment options to treat the tennis elbow symptoms. These may include:

• Limit use and rest the arm from activities that worsen symptoms.
• Splints or braces may be ordered to decrease stress on the injured tissues
• Ice packs to the elbow for swelling
• Avoid activities that tend to bring on the symptoms and increase stress on the tendons
• Anti-inflammatory medications and/or steroid injections to treat pain and swelling may be ordered.
• Occupational Therapy may be ordered for strengthening and stretching exercises to the forearm once your symptoms have decreased
• Pulsed Ultrasound may be utilized to increase blood flow and healing to the injured tendons.

If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend you undergo a surgical procedure to treat Tennis Elbow called lateral epicondyle release surgery. Your surgeon will decide whether to perform your surgery in the traditional manner or endoscopically. Traditional surgery involves up to a 2” incision in the elbow area, whereas arthroscopic surgery involves one or two smaller incisions and the use of an arthroscope with a camera for viewing internal structures.

The television camera attached to the endoscope displays the image of the joint on a television screen, allowing the surgeon to look throughout the elbow joint at cartilage, ligaments, nerves and bone.
The benefits of endoscopic surgery compared to the alternative, open elbow surgery, include:

• Smaller incisions
• Minimal soft tissue trauma
• Less pain
• Faster healing time
• Lower infection rate
• Less scarring
• Earlier mobilization
• Usually performed as outpatient day surgery

Your surgeon will decide which options are best for you depending on your specific circumstances.

Golfer’s Elbow

Golfer’s elbow, also called Medial Epicondylitis, is a painful condition occurring from repeated muscle contractions in the forearm that leads to inflammation and microtears in the tendons that attach to the medial epicondyle. The medial epicondyle is the bony prominence that is felt on the inside of the elbow.

Golfer’s elbow and Tennis Elbow are similar except that Golfer’s elbow occurs on the inside of the elbow and Tennis Elbow occurs on the outside of the elbow. Both conditions are a type of Tendonitis which literally means “inflammation of the tendons”.

Signs and symptoms

Signs and symptoms of Golfer’s Elbow can include the following:

• Elbow pain that appears suddenly or gradually
• Achy pain to the inner side of the elbow during activity
• Elbow stiffness with decreased range of motion
• Pain may radiate to the inner forearm, hand or wrist
• Weakened grip
• Pain worsens with gripping objects
• Pain is exacerbated in the elbow when the wrist is flexed or bent forward toward the forearm

Causes

Golfer’s Elbow is usually caused by overuse of the forearm muscles and tendons that control wrist and finger movement but may also be caused by direct trauma such as with a fall, car accident, or work injury.

Golfer’s elbow is commonly seen in golfer’s, hence the name, especially when poor technique or unsuitable equipment is used when hitting the ball. Other common causes include any activity that requires repetitive motion of the forearm such as: painting, hammering, typing, raking, pitching sports, gardening, shoveling, fencing, and playing golf.

Diagnosis

Golfer’s Elbow should be evaluated by an Orthopaedic specialist for proper diagnosis and treatment.

• Medical History
• Physical Examination
• Your physician may order an x-ray to rule out a fracture or arthritis as the cause of your pain.
• Occasionally, if the diagnosis is unclear, your physician may order further tests to confirm golfer’s elbow such as MRI, ultrasonography, and injection test

Conservative Treatment Options

Your physician will recommend conservative treatment options to treat the symptoms associated with Golfer’s Elbow. These may include the following:

• Activity Restrictions: Limit use and rest the arm from activities that worsen symptoms
• Orthotics: Splints or braces may be ordered to decrease stress on the injured tissues
• Ice: Ice packs applied to the injury will help diminish swelling and pain. Ice should be applied over a towel to the affected area for 20 minutes four times a day for a couple days. Never place ice directly over the skin
• Medications: Anti-inflammatory medications and/or steroid injections may be ordered to treat the pain and swelling
• Occupational Therapy: OT may be ordered for strengthening and stretching exercises to the forearm once your symptoms have decreased
• Pulsed Ultrasound: A non-invasive treatment used by therapists to break up scar tissue and increase blood flow to the injured tendons to promote healing
• Professional instruction: Consulting with a sports professional to assess and instruct in proper swing technique and appropriate equipment may be recommended to prevent recurrence

Surgery

If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend surgery to treat Golfers Elbow. The goal of surgery to treat Golfers Elbow is to remove the diseased tissue around the inner elbow, improve blood supply to the area to promote healing, and alleviate the patient’s symptoms.

Shoulder

Rotator Cuff Tendonitis

Bicipital tendonitis is the inflammation of the biceps tendon, the tissue that connects muscle to bone in your upper arm, causing pain in the upper arm and shoulder. It is more common in men in the age group of 40 to 60 years and occurs during many sports activities like tennis, baseball, weightlifting and kayaking where overhead movement is involved.

Anatomy

Two separate tendons or heads in the upper arm, the long head and short head, converge to form a single muscle called the biceps muscle. The long head passes through the shoulder joint and into the bicipital groove, which is a depression in the arm bone. When the tendon get inflamed due to stress or injury, as seen in bicipital tendinitis, it rubs against the joint or groove, causing pain.

Causes

The common causes of bicipital tendonitis include overuse of the arm and shoulder especially in sports, inflammatory diseases like bursitis or arthritis, injury or infection.

Symptoms

Bicipital tendinitis is characterized by pain in the shoulder, which may travel to the forearm, tenderness at the region where the biceps contacts the shoulder, reduced shoulder movement, and a bulge in the biceps if a tendon ruptures.

Diagnosis

On presenting with shoulder pain, your doctor will conduct a thorough examination of your shoulder to identify the site of inflammation and the movements that cause pain. X-rays and MRI scan may be suggested to confirm on the diagnosis.

Treatment

First line treatment options include rest, ice, compression and elevation (RICE) and non-steroidal anti-inflammatory drugs (NSAIDs) to bring down the inflammation and pain. Your arm may be placed in a sling for comfort. Alternatively, an anesthetic and steroid can be injected in your shoulder.

If conservative treatment does not give relief, surgery is performed. Through surgery, the inflamed tissue can be removed (biceps debridement), the long head of the tendon can be cut so that it does not rub against the joint and groove (biceps tenotomy), or the tendon can be cut and reattached lower down the arm (biceps tenodesis).

Prevention

Bicipital tendonitis can be prevented by modifying overhead hand activities with guidance from a physiotherapist.

Hip

Snapping Hip Syndrome

The hip is an important joint that helps us walk, run and jump. The ball-and-socket joint in the hip is formed between the round end of the femur (thighbone) and the cup-shaped socket of the acetabulum (part of the hip bone). Joint stability in the hip region is achieved through the labrum (a strong fibrous cartilage), which covers the acetabulum and seals it, and ligaments (tissue connecting bone to bone) and tendons (tissue connecting muscle to bone) that encase the hip and control the hip movements.

What is snapping hip syndrome?

Snapping hip syndrome is a condition in which you hear or feel a snapping sound in the hip while swinging your legs, running, walking or while getting up from the chair. Movement of the muscles or tendons over a bony protrusion in the hip region gives rise to the snapping sound, which can occur in the back, front or side of the hip. It is usually painless and harmless, but may be accompanied with pain and weakness in some. People who are involved in sports or dance where they have to repeatedly bend are most vulnerable and it may affect their performance. Sometimes, the syndrome can lead to bursitis, a painful swelling of the fluid-filled sacs called bursae that cushion the hip joint.

Causes

The most common cause of snapping hip syndrome is tightness in the muscles and tendons surrounding the hip. Sometimes, a loose piece of cartilage, a cartilage tear or pieces of broken cartilage or bone in the joint space can lead to the snapping sound. This may also lock the hip causing disability along with the pain. However, this is less common.

Diagnosis

The doctor will discuss your medical history and symptoms with you, and will conduct a physical examination to detect the exact cause of snapping. You may be asked to reproduce the snapping sound by moving your hip in different directions. Imaging tests may be ordered by your doctor to rule out bone and joint problems.

Treatment

Rest and modification of activities may be suggested initially by your doctor followed by conservative therapeutic options. The therapeutic strategies for snapping hip include:

Home care

A few home remedies can be followed if you experience minor snapping hip pain, which include:

• Applying ice to the affected area
• Using NSAIDs to reduce discomfort
• Avoiding repetitive hip movements by changing your activities

Consult your doctor if the discomfort persists even after following the home remedies.

Physical Therapy

Your doctor may teach you certain exercises to strengthen and stretch the musculature surrounding the hip. You may be guided by a physical therapist. Particular tendon stretching exercises such as iliotibial band stretch and piriformis stretch will be indicated depending on the type of snapping you experience.

Corticosteroid Injection

Your doctor may recommend a corticosteroid to be injected into the bursa to reduce the pain and inflammation in the hip joint in case you have hip bursitis.

Surgical Treatment

Surgery is recommended when conservative approaches do not have an effect in resolving the snapping hip syndrome (which is rare). The type of surgery will depend on the factors that cause snapping hip. Surgical procedures include:

• Hip arthroscopy: This procedure is usually used to remove or repair the torn labrum. Your surgeon will insert an arthroscope (small camera) into your hip joint so that minute surgical instruments can be guided with the help of images displayed on a large screen. Very small cuts are required with this procedure due to the presence of a small arthroscope and surgical instruments.
• Open procedure: The open surgery can help your surgeon to gain better access to the hip problem. An open incision of several centimeters will be made to resolve the issue of snapping hip.
  Your surgeon will discuss the best surgical option depending on your situation.

Hip Bursitis

Hip bursitis is a painful condition caused by inflammation of a bursa in the hip. Bursae are fluid filled sacs present in joints between bone and soft tissue to reduce friction and provide cushioning during movement.

The bony prominence of the hip is called greater trochanter and is present on the outer side of the upper thigh bone or femur. The bursa overlying it is called trochanteric bursa. Another bursa is located towards the groin region and is called iliopsoas bursa. Bursitis of the trochanteric bursa is more common than that of iliopsoas bursa.

Causes

Trochanteric bursitis is often seen in people involved in sports such as football and soccer which involve a lot of running. This can lead to overuse and irritation of the bursa causing inflammation. Bursitis may sometimes result from an injury or fall to the hip or after a surgical procedure of the hip. Spine disease, rheumatoid arthritis and leg length inequality increases the risk for developing hip bursitis.

Symptoms

Trochanteric bursitis results in pain on the outer side of the hip which usually increases with prolonged walking or climbing stairs. The pain is felt more while getting up from a chair and in the night when lying on the affected side. Inflammation of the iliopsoas bursa however results in pain in the groin region.

Diagnosis

Tenderness and swelling in the area of pain over the bursa during the physical examination of the hip confirms the diagnosis of Hip Bursitis. To check for any bone spurs that could be causing irritation of the bursa your doctor may order an X-ray. If the reason for the pain is not very clear the doctor may order an MRI to view the soft tissues and structures not visible on X-ray.

Conservative Treatment Options

Treatment goals for bursitis are focused on resolving the inflammation and pain. Rest is advised and activities causing the bursitis pain are restricted. Anti-inflammatory medications are prescribed to reduce the inflammation and pain. Physical therapy and treatments with heat, ice and ultrasound sometimes are recommended. An injection of corticosteroid medicine may be administered to reduce the inflammation. Sometimes a second injection is necessary if the pain returns after a few months. These nonsurgical treatments provide relief from hip bursitis in the majority of cases. 

Surgery

Sometimes, however, your doctor may recommend surgical removal of the bursa if you do not respond to conservative treatment measures.

Knee & Leg

Stress Fractures

A stress fracture is described as a small crack in the bone which occurs from an overuse injury of a bone. It commonly develops in the weight bearing bones of the lower leg and foot. When the muscles of the foot are overworked or stressed, they are unable to absorb the stress and when this happens the muscles transfer the stress to the bone which results in stress fracture.

Stress fractures are caused by a rapid increase in the intensity of exercise. They can also be caused by impact on a hard surface, improper footwear, and increased physical activity. Athletes participating in certain sports such as basketball, tennis or gymnastics are at a greater risk of developing stress fractures. During these sports the repetitive stress of the foot strike on a hard surface causing trauma and muscle fatigue. An athlete with inadequate rest between workouts can also develop stress fracture.

Females are at a greater risk of developing stress fracture than males, and may be related to a condition referred to as "female athlete triad". It is a combination of eating disorders, amenorrhea (irregular menstrual cycle), and osteoporosis (thinning of the bones). The risk of developing stress fracture increases in females if the bone weight decreases.

The most common symptom is pain in the foot which usually gets worse during exercises and decreases upon resting. Swelling, bruising, and tenderness may also occur at a specific point.

Your doctor will diagnosis the condition after discussing symptoms and risk factors and examines the foot and ankle. Some of the diagnostic tests such as X-ray, MRI scan or bone scan may be required to confirm the fracture.

Treatment

Stress fractures can be treated by non-surgical approach which includes rest and limiting the physical activities that involves foot and ankle. If children return too quickly to the activity that has caused stress fracture, it may lead to chronic problems such as harder-to-heal stress fractures. Re-injury can also occur without allowing the stress fracture to completely heal.

Protective footwear may be recommended which helps to reduce stress on the foot. Your doctor may apply cast to the foot to immobilize the leg which also helps to remove the stress. Crutches may be used to prevent the weight of the foot until the stress fracture is healed completely.

Surgery may be required if the fracture is not healed completely by non-surgical treatment. Your doctor makes an incision on the foot and uses internal fixators such as wires, pins, or plates to attach the broken bones of the foot together until healing happens after which these fixators can be removed or may be permanently left inside the body.

Some of the following measures may help to prevent stress fractures:

• Ensure to start any new sport activity slowly and progress gradually
• Cross-training: You may use more than one exercise with the same intention to prevent injury. For example you may run on even days and ride a bike on odd days, instead of running every day to reduce the risk of injury from overuse. This limits the stress occurring on specific muscles as different activities use muscles in different ways.
• Ensure to maintain a healthy diet and include calcium and vitamin D-rich foods in your diet
• Ensure that your child uses proper footwear or shoes for any sports activity and avoid using old or worn out shoes
• If your child complains of pain and swelling then immediately stop the activities and make sure that your child rests for few days

Shin Splints

“Shin splints” is used to describe the pain and inflammation of the tendons, muscles and bone tissue around the tibia or shine bone (a large bone in the lower leg). It occurs as a result of vigorous physical activity such as exercise or sports. The condition is also referred to as medial tibial stress syndrome (MTSS).

The common cause of shin splints is overuse of muscles and bone tissue of the tibia because of repetitive sports activity and a sudden change in the physical activity level. The other causes of shin splints include:

• Stress fractures (tiny, hairline breaks) of the leg bone may cause sharp pain.
• Tendonitis caused by partial tear in the tendon.
• Chronic exertional compartment syndrome: Swelling of muscles with exertion as a result, pressure is increased within the muscle compartment. Pain is severe because of loss of blood supply to the muscle.

Flat feet or a rigid arch and use of improper or worn-out footwear while exercising may increase the risk of developing shin splints. Runners and dancers are at a higher risk of developing shin splints.

The most commonly occurring symptoms include pain in front side of the lower leg. Some of the children experience pain during or after exercises. Mild swelling may be accompanied in the lower leg because of which your child may feel weak or numb.

Your doctor will diagnose the condition through physical examination of the lower leg. In some cases, an X-ray or other tests may be required to detect stress fractures of the tibia bone.
The treatment for shin splints consists of non-surgical and surgical procedures. The non-surgical or conservative procedure includes:

• Rest: Ensure that your child takes adequate rest and avoid activity that causes pain for at least 2-4 weeks. They can try low-impact exercises, such as swimming, bicycling or water running.
• Non-steroidal anti-inflammatory medicines are given to reduce pain and swelling.
• Ice: Apply ice packs wrapped over a cloth to the affected area for 15-20 minutes four times a day for several days. Never place ice directly over the skin.
• Compression: Wrap the leg with an elastic bandage which helps to reduce swelling.
• Flexibility exercises: It involves exercises to stretch the leg muscles to reduce pain and improve the muscle strength.
• Supportive shoes: Ensure that your child wear shoes that provide good cushioning and support the feet as it helps reduce the stress on the shin bone.

Surgical treatment is an option that is considered only in very severe cases when the conservative methods fail to relieve pain. Surgery may be needed in conditions where the pain becomes severe due to compartment syndrome.

Fasciotomy is a surgical procedure where the tough and fibrous tissue is split to relieve the pressure built up within muscle compartments.

Shin splints can be prevented by following these measures:

• Ensure that your child always wear a proper fitting athletic shoe with good support
• Make sure that your child is aware of warm up exercises or stretching the leg muscles before starting any vigorous activity
• Avoid running on hard surfaces like concrete or hard surface
• Ensure that your child starts any new activity slowly and progress gradually by increasing the duration and frequency of exercise regimen

Chondromalacia

The patella also called the kneecap is a small bone present on the front of your knee joint. The underside of the patella is covered by cartilage that allows smooth gliding of the knee with movement. Overuse or misalignment of the patella can cause wear and tear of the cartilage.

Chondromalacia patella is a common condition characterized by softening, weakening and damage of the cartilage. The condition is most often seen among young athletes and older adults who have arthritis of the knee. It is especially seen in women.

Causes

There is no explicit reason why the cartilage damage occurs. However, it is associated with improper knee alignment or imbalance in the tightness of the muscles holding it in place. Overuse of the knee in certain sports activities may cause wear and tear of the cartilage. This may cause rubbing or grinding of the kneecap against the bone instead of it smoothly gliding over the knee joint.

Chondromalacia patella may also be caused due to injuries such as fractures or dislocations, or may develop as a part of your ageing process.

Symptoms

Chondromalacia patella is the most common cause of knee pain. Called patellofemoral pain, it is characterized by the following:

• Pain in front, around or behind your knee
• Pain that gets worse when climbing up or down the stairs, sitting or standing for long periods, or when extreme pressure is applied on the knee

Other symptoms may include:

• Grinding or cracking sensation or noise when you move your knee
• Rarely, swelling or fluid effusion in your knee joint

Diagnosis

Your doctor will conduct a physical examination by applying pressure on different areas of your knee and moving your leg in different positions. You may be asked to undergo imaging tests including an X-ray, CT scan and MRI scan to obtain detailed images of the bones and soft tissues of the knee.

Treatment

The treatment of chondromalacia patella initially involves simple conservative procedures. You may be asked to rest your knee and avoid any activity that may strain the knee joint. Your doctor may prescribe painkillers and anti-inflammatory drugs to relieve pain and reduce swelling. Physiotherapy may help you to improve the muscle strength, decrease stress on your knee and aid in correcting the misalignment. Wearing support braces and taping around the knee may help you protect your joint, reduce pain and improve alignment. Application of ice on the knee may be recommended after exercise.

When non-surgical treatment does not relieve pain, your doctor may recommend surgical treatment. Surgery may involve:

• Arthroscopy: your doctor inserts a device called an arthroscope (thin tube with a camera and light attached) through a small incision. This helps to clearly view the surgical site while other instruments are inserted to remove fragments of the damaged cartilage.
• Realignment: your surgeon may operate on your knee to realign the position of your knee cap and release the pressure over the cartilage.

Your doctor will examine your condition and provide you with best treatment option.

Foot & Ankle

Achilles Tendonitis

An Achilles tendon is a group of tough fibrous tissue that connects the calf muscles to the heel bone. It functions so as to elevate the heel while walking or running.

The two major problems associated with the Achilles tendon are:

• Achilles tendonitis: refers to the inflammation of the tendon.
• Achilles tendinosis: a condition that originates due to degeneration of the tendon caused by the unresolved inflammation. The tendon develops minute tears or pores in the tissue thereby losing its unique structure.

Sometimes, because of degeneration, an Achilles tendon also tears or ruptures either partially or completely causing pain or loss of movement.

Causes

Constant overuse or repetitive activities can cause Achilles tendon disorders. These activities exert excessive stress on the tendon and lead to microtears. This damage or injury of the tendon results in pain.

People involved in activities like sports and exercises are more prone to develop Achilles tendon disorders. It is also commonly seen in people whose occupation puts lot of pressure on their feet and ankles. Simple movements like running, jumping, stretching, and improper shoes can also result in rupture of the tendon.

Symptoms

Symptoms related to Achilles tendon conditions include:

• Swelling and bruising
• Mild or severe pain
• Stiffness
• Loss of strength
• Decreased movements of the ankle
• Muscle weakness or tenderness
• Difficulty in walking or standing

Diagnosis

Diagnosis is based on the following:

• Medical history
• Physical examination of the foot and ankle to assess the movements and condition of the tendon
• Radiological investigations like foot or ankle X-rays, scans or MRI

Treatment

Treatment options depend on the duration and extent of injury to the tendon. Mild cases can be treated by the following approaches:

• Get adequate rest.
• Start medications as prescribed by your doctor which help relieve pain and inflammation.
• Apply ice bags over a towel to the affected area for about 15-20 minutes to reduce swelling and inflammation.
• Restrict the activities that cause pain and stress for a short duration.
• Immobilization through the use of a cast, splint, brace, walking boot, or other device which prevents the movements of the leg and assists faster healing of the tendon.
• Physical therapy modalities such as strengthening exercises, massage, ultrasound therapy, stretching, and a walking rehab program help to improve range of motion.
• Surgery is indicated only in severe cases and depends on the age and activity level of the individual, extent of damage to the tendon, and other factors.

Prevention

Strictly follow the post-treatment instructions and wear appropriate shoes for the foot type and activity as recommended by your doctor to prevent the recurrence of the condition.

Tarsal Tunnel Syndrome

Tarsal tunnel is the gap that is formed between the underlying bones of the foot and the overlying tough fibrous tissue. Tarsal tunnel syndrome refers to a condition where the posterior tibial nerve that lies within the tarsal tunnel is compressed. The condition occurs when the tibial nerve is pinched.

Exact cause of the condition is not known but certain conditions such as fractures, bone spurs, ganglions, benign tumors, muscle impingement, or foot deformities are known to increase the risk of developing tarsal tunnel syndrome. Other medical conditions such arthritis can cause swelling of the joints that may compress the nerve. Scar tissue formed after an ankle injury and growth of abnormal blood vessels can press against the nerve resulting in compression.

Most children with tarsal tunnel syndrome complain of pain, numbness, and burning or tingling sensation at the bottom of the foot and heel.

Tarsal tunnel syndrome can be diagnosed by Tinel’s test. Tinel’s test is performed by tapping the posterior tibial nerve lightly which produces pain and other symptoms indicating tarsal tunnel syndrome.

Tarsal tunnel syndrome may be treated with conservative approaches which include:

• Non-steroidal anti-inflammatory medications to relieve pain and reduce swelling.
• Corticosteroid injection that are injected into the area around the nerve to decrease the swelling.
• Use orthotics, such as specially designed shoe inserts or change in foot wears will help to support the arch of the foot and take the tension off the tibial nerve.

Surgery is often considered a last resort only when conservative treatments fail to resolve the condition and provide symptomatic relief. Your doctor may perform tarsal tunnel release surgery to treat the condition. During this surgery an incision is made in the tarsal tunnel and the pressure on the tibial nerve is released.