Neuroma of the Calcaneal Tibial Nerve
Like carpal tunnel syndrome in the wrist, tarsal tunnel syndrome (TTS) of the foot is caused by pressure on a nerve. In both cases, the nerve is pinched, pressed, or entrapped as it passes through a tunnel formed by a ligament stretched across the ankle bones. TTS occurs in the foot as a result of pressure from the laciniate ligament pressing on the tibial nerve.
In this study surgeons report on a 10-year case of heel and ankle pain from TTS. The patient was a 44-year-old woman. She had tried all kinds of conservative treatment with only temporary relief of her symptoms.
She had many tests done over the years to find out what was wrong. X-rays and MRI showed a large bone spur on her calcaneus (heel bone). The surgeon removed the bone spur and she was in a cast for four weeks. Then she wore a fracture boot for another four weeks.
She still had pain so another nerve test was done. Previous nerve conduction velocity (NCV) tests were negative. This time the NCV test showed changes in the tibial nerve function. She was diagnosed with TTS. Part of the nerve was removed and found to have a neuroma (nerve tumor).
Three months later the patient's symptoms were almost all gone. Two years later, she was wearing normal shoes and walking pain free for long distances.
The authors report that this complex case was difficult to diagnose and treat correctly. The patient's symptoms weren't typical for a diagnosis of calcaneal nerve neuroma. The pathology report described the neuroma caused by trauma, most likely from body weight (the patient was obese).
J. Bernard Bush, MD, and Robert J. Treuting, MD. Neuroma of the Calcaneal Branch of the Tibial Nerve: A Case Report. In The American Journal of Orthopedics. June 2006. Vol. 35. No. 6. Pp. 276-279.