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Anterior Tarsal Tunnel Syndrome

Updated: Jan 26

In this section Cypress Foot and Ankle specialist Dr. Christopher Correa discusses anterior tarsal tunnel syndrome as a cause of dorsal foot pain (top of foot pain). Anterior Tarsal Tunnel Syndrome is an impingement of the deep peroneal nerve that occurs on the dorsal (top) portion of the foot. While most mid foot pain from arthritis, tendonitis, ligament strain or stress fracture has a sharping stabbing character to it, Anterior Tarsal Tunnel Syndrome typically has a burning or shooting character and may radiate up the leg or down to the toes. Patients often complain of pain when anything contacts or applies pressure to the top of the foot. This leads to difficulty wearing shoes with laces and patients will often compensate by not tying their shoes very tight or at all. The cause of Anterior Tarsal Tunnel Syndrome is when the deep peroneal nerve is compressed by another structure at the dorsal mid foot area. The structure which applies pressure to the nerve varies from case to case but can include one or multiple of the following –

  • Bone spurs from arthritis of the 1st or 2nd Tarsometatarsal joint.

  • Soft tissue mass such as a ganglion.

  • Compression under the medial tendon of the extensor digitorum brevis (AKA Extensor Hallucis Brevis)

  • Constriction under the inferior extensor retinaculum.

Dorsal foot anatomy
Anatomy of the top of the foot

Treatments for Anterior tarsal Tunnel Syndrome

Alternate lacing patter for top of foot pain

Conservative care revolves around offloading the dorsal foot with non-constrictive stiff soled shoe gear. Shoes with laces can be re-laced to avoid applying pressure to the affected area. Additionally, NSAIDs such as Aleve or Ibuprofen may help reduce symptoms. If the symptoms cannot be reduced or resolved with shoe gear modifications, then a thorough physical exam with x rays and occasional advanced imaging is necessary to try and determine the exact cause of the symptoms. Once the source of the impingement is identified surgical planning can begin. Surgery usually includes a release of most overlying structures followed by spur removal and/or soft tissue mass removal if present. Prognosis following this procedure is good with symptoms resolving relatively quickly. Patients usually have minimal pain and report little disruption in their ability to bear weight. If you or someone you know is struggling with dorsal foot pain, give the experts at Select Foot and Ankle Specialists a call to day to make an appointment and take the first step towards recovery today!

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