Procedure

Tarsal Tunnel Injection

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Tarsal Tunnel Injection

  • See Also
  1. Tarsal Tunnel Syndrome
  2. Joint Injection
  3. Injectable Corticosteroid
  • Indications
  1. Tarsal Tunnel Syndrome refractory to other measures
  • Preparation
  1. Needle
    1. Gauge: 22 to 27
    2. Length: 1.0 to 1.5 inches
  2. Syringe: 3 to 5 ml
  3. Corticosteroid options
    1. Betamethasone (Celestone) 0.5 ml of 6 mg/ml
    2. Methylprednisolone (Solu-Medrol): 0.5 ml of 40 mg/ml
    3. Triamcinolone (Kenalog) 0.5 ml of 40 mg/ml
  4. Anesthetic
    1. Lidocaine 1%: 1 to 2 ml or
    2. Bupivacaine 0.25% or 0.5% 1 to 2 ml
    3. Ropivacaine 0.25 to 0.5% 1-2 ml
  • Technique
  • Anatomic
  1. Patient position
    1. Lateral decubitus position with affected foot down
  2. Anatomic Landmarks
    1. Tunnel housing posterior tibial nerve
      1. Posterior to medial malleolus
      2. Lies immediately behind posterior tibial tendon
    2. Perform Tinel's Test behind posterior tibial tendon
      1. Mark point where tapping reproduces symptoms
  3. Sterilize local skin with Betadine or Hibiclens
  4. Insert needle 2 cm proximal to marked landmark
    1. Angle needle 30 degrees off skin surface
    2. Direct needle distally via marked point along tunnel
    3. Aspirate before injecting
    4. Inject at approximately 4 mm depth of needle insertion
  5. Patient lies supine for several minutes after procedure
    1. Distribute with passive foot range of motion
  1. Technique is similar to anatomic as above
  2. Use high frequency linear probe
    1. Position probe in short axis (transverse to the proximal foot) over the Retinaculum at the medial ankle
    2. Needle is inserted in-plane
      1. From posterior-inferior to anterior-superior
  • Follow-up Instructions
  1. No stress to foot for 2 weeks after injection
  2. Examine again in 3 weeks post-injection
  • References
  1. Tallia (2003) Am Fam Physician 68(7):1356-62 [PubMed]
  2. Wilcox (2026) Am Fam Physician 113(5): 431-9 [PubMed]