Tarsal Tunnel Syndrome

Testimonials
Justin, Northern Ireland
Justin, Northern Ireland
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My mother was experiencing problems with some level of pain and a lack of mobility in one hip. Locally she was advised that she could not have the appropriate treatment for 22 months . At eighty years of age that was a poor option. We were advised to contact Nordorthapaedics. The clinic was comparable to any private facility in the UK. Everything about the experience at Nordorthapaedics was positive. Everything from our first contact to our journey home was professionally managed by a team of courteous individuals. I would thoroughly recommend this service.
Annette, Wales
Annette, Wales
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The whole experience was excellent from making travel arrangements, all the pre-operation checks, making the payment. The clinic was so well run beautifully clean and the staff were marvellous. I would highly recommend taking a few days at the rehabilitation center as the post-op treatment received was outstanding and a great aide to recovery. I received every day physio, massage, hot and cold treatment, things that you wouldn’t get on the NHS. I can highly recommend having the operation in Lithuania it truly was a memorable experience.
Ronnie, Northern Ireland
Ronnie, Northern Ireland
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Hi, I'm Ronnie Kelly from Randalstown, Northern Ireland. From my initial inquiry Jurate at Nordorthopaedics was fantastic answering all my question almost immediately. I booked the flights, gave her the dates and the rest was plain sailing. Everything was organised with professional precision. From being met at the airport, to surgery, to recovery at rehabilitation center and back to the airport every detail was covered with constant emails and messages. I couldn't recommend this Clinic and Rehabilitation Centre any higher for its total professionalism and after care.
Karen, Alberta, Canada
Karen, Alberta, Canada
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Th clinic looked almost too good to be true but everything they claim is accurate. The care I received from the physician and nursing staff was very caring and excellent. Also there is the option for aftercare at a rehab facility that I highly recommend. It gives you time to recover from the surgery before the long flight home. The customer service representative Jurate is very efficient and will promptly answer any questions you have. Canada may seem like a long way from Lithuania but I feel it was totally worth the trip and I am planning to go back and have the other hip replaced.
John, Ireland
John, Ireland
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This is very simple because I recommend everything about nordorthopaedics. Firstly the administration staff are very professional and helpful with any problems you may have,and I would especially mention Aurelija along with her colleague Jurate for their attention to detail. Travelling to a different country can be daunting but the trip is carefully planned with collection from airport, transport to hotel and clinics. The clinics and rehabilitation center are of the highest quality and all the staff, nurses and doctors are really caring and helpful.
Julie, Northern Ireland
Julie, Northern Ireland
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Everything from airport to being picked up , hotel , hospital , loved it all it was the best decision I ever made , I tell everyone here in Ireland about it , I had the whole thing organised with Agnes help in four weeks , staff at hospital fabulous , care fabulous , doctor and anethnetist fabulous , honestly have nothing but good to say . If I need another hip I’ll be there in a heartbeat I’d never wait years here at home never . Thank you all
Ray, Spain, UK expat
Ray, Spain, UK expat
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My experience from beginning to end was one of the utmost pleasure. Not just my own surgery, rotator cuff repair but that of a fellow patient who was up and walking within hours after knee surgery. All made possible by the administration staff, nursing staff and the highly qualified surgeons. Nordorthapaedic deserve a gold medal for their obvious high standards. I award them one as such. After searching the web for a suitable clinic it was an obvious choice to select this clinic. And how happy am I that I did. The high standards of cleanliness and professional care shine out.
David, England
David, England
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Having been rejected by the NHS I chose to look abroad for my options. My friends all thought I was mad to consider Lithuania, nothing could be further from the truth. From my initial contact phone call I have experienced the highest standards of professionalism and service throughout . I must declare that I am quite a tough person to satisfy as I have had a career as a Quality Management Consultant and auditing suppliers. The clinic is first class. It is equal to any private hospital in the uk. I would wholeheartedly recommend the clinic to anyone in a similar position.
Michael, West Midlands, UK
Michael, West Midlands, UK
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I recently had a total hip replacement at Nordorthopedics. The whole experience from the initial contact through to the rehabilitation treatment was flawless, Dr Saraunas Tarasevicius and all at the hospital were unbelievably open and efficient, putting any doubts at rest. I was up and walking with crutches the day after surgery. At the rehabilitation centre the aftercare resulted in being able to walk 2 miles with 1 crutch by the time I left for home 9 days after surgery. Jurate deserves a special mention for organising almost every aspect, nothing seemed to be much trouble. I cannot recommend Nordorthopaedics enough.
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Refund from NHS and HSE
HSE & NHS

The clinic helps patients with the documents needed to claim a refund from NHS & HSE for medical treatment abroad. It applies to patients who are insured under the UK and Irish systems and may not get the surgery due to long waiting times. 

Rehabilitation package

The rehabilitation centre is located at a SPA resort town called Druskininkai. It is equipped with modern facilities. The professionals there have years of experience working with people after various surgeries and injuries. 

Rehabilitation in Lithuania – from € 130 / £ 116 per day

  • personalized rehabilitation course
  • room with TV and private bathroom
  • three meals a day
  • all medication needed
  • transportation to/from the rehabilitation centre

An individual rehabilitation program is prepared for each patient depending on the type of surgery, general patient‘s well-being, health status and other factors.

Our rehabilitation centre
Our clinic
What sets us apart from other clinics?

Our clinic works with highly professional and educated surgeons. They have 10-20 years of experience in the field of orthopaedic surgery. They each perform 500 surgeries per year. Our surgeons are board-certified in the UK. Moreover, our surgeons are members of various prestigious surgical societies both Lithuanian and international. Find more information about our surgeons here.

The clinic is equipped with modern diagnostic and surgical facilities, all analogous to those in Western European clinics. You will be looked after by professional English speaking staff.
The wards are fully furnished and equipped with TV, WC and air conditioning. Free Wi-Fi is available while staying in the clinic.

Our clinic is one of the biggest surgical centres in the Baltic region. We work with patients from various countries, among which Great Britain, Norway, Sweden, Denmark, Germany, Switzerland, etc.
Despite the size of the clinic we provide our patients with personal care and assistance. The majority of big public hospitals due to high volume of patients do not have enough resources and medical personnel to pay personal attention to each patient. Whereas we are fully focused on providing exceptional care and undivided attention for our patients.
Without any additional fees patients are tended in the clinic as long as they need. We only discharge our patients from the clinic when they are in a good health state and ready to leave.

All inclusive price, which is twice lower than in Western European clinics.
Our clinic works with medical professionals of highest education and experience level and uses the same materials as the clinics in Western Europe. More often than not, the quality of our clinic‘s facilities exceed the ones in Western European clinics.
The price difference is only due to considerably lower average salaries and taxes – which is the main reason for medical travel everywhere around the world.

During your entire stay in Lithuania you will receive personal care as well as transport to and from the clinic, hotel, and airport. You will not have to worry about a thing. You will be assisted from the moment of plane landing in Vilnius or Kaunas airport till your departure.

Our clinic is flexible date-wise and can usually arrange your surgery on the date convenient for you.

Everyone in our clinic speaks English, including customer service desk, nurses, assistants and the surgeon.

Our clinic is the only clinic in Europe that offers customer service in 8 languages, among which English, Norwegian, Swedish, Danish, German, Spanish, Russian, and Lithuanian.

We can give you lots of testimonials from our previous patients that had orthopaedic surgery in our clinic. They can tell you their stories and help you make a decision.

2-3 hour regular flights operate from all main airports in the UK & Ireland. Lithuania is closer than you thought. You can find the list of direct flights here. Please note that airlines constantly add new flights and new destinations, therefore feel free to contact us if you need help choosing the flight that suits you best.

Lithuania has been a part of the EU and NATO since 2004. Lithuania has one of the fastest growing economies in the whole region and the second fastest internet speed in the world. Lithuanian medical schools have trained many medical professionals who are highly appreciated and employed by many foreign hospitals, among which hospitals in the UK.

Defining tarsal tunnel syndrome

Tarsal tunnel syndrome (TTS), also known as the posterior tibial neuralgia or entrapment neuropathy, defines pain and paraesthesias over the sole of the foot which are caused by entrapment or compression of the posterior tibial nerve or any of its branches. The cause of TTS can be identified in only 50% of cases and include fracture callus (the bony healing tissue around the ends of the broken bone), exostosis (outgrowth of the bone), lipoma, ganglion of the tendon, engorged venous plexus, valgus deformity (outward deviation of the foot).

Anatomy of tarsal tunnel

This syndrome was called the Tarsal tunnel syndrome because of the topographic anatomy of the posterior tibial nerve. This nerve threads the narrow tarsal tunnel which is a structure of a dense fibrous tissue. The medial wall of the tarsal tunnel is the tibia and the lateral wall is the flexor retinaculum. The flexor retinaculum is a fibrous band located in the medial part of the tarsus (behind the medial malleolus). It forms a canal (the tarsal tunnel) for the tendons, vessels and the posterior tibial nerve.

Symptoms of tarsal tunnel syndrome

TTS usually causes pain or paraesthesias (abnormal sensations) or numbness over the sole of the foot. Actually, the symptoms vary a lot. Most patients define the pain as burning or a dull ache. However, it can also manifest as crampy or spastic pain. Moreover, in some patients the pain radiates up to the medial calf.

In addition, prolonged standing or walking aggravates the symptoms while rest usually relieves them. Furthermore, some patients report that the symptoms flare-up at night while sleeping in the bed.

Physical examination

In order to diagnose the Tarsal tunnel syndrome, some tests should be done after evaluating the symptoms.
The test called Tinel‘s sign is probably the most significant. In a test  a doctor  taps the medial side of the ankle. If the posterior tibial nerve is compressed or entrapped, the patient feels tingling sensation that radiates toward the toes.

The physical examination may also reveal reduced sensitivity to light touch or temperature.

The doctor may also ask the patient to turn the sole of the foot outward and point the toes upward in order to verify if these motions aggravate the symptoms (which is typical of TTS).

Other tests

Usually, the diagnosis of the TTS is based on the specific symptoms combined with the supportive physical findings.

In addition, in most cases the diagnosis is supported with electrodiagnostic tests. These are Electromyography test (EMG) or Nerve Conduction Velocity test (NCV).

However, sometimes the clinical findings remain nondiagnostic. In these cases plain x-rays and CT (computed tomography) scans are performed in order to detect skeletal abnormalities that may  cause the compression of the posterior tibial nerve. Moreover, MRI (Magnetic Resonance Imaging) and ultrasound may be useful in identifying tendon inflammation and lesions or increased vascularity.

Treatment of tarsal tunnel syndrome

The treatment of the TTS depends on the severity of the condition and the cause of it (if it is possible to identify it).

The nonsurgical treatment includes anti-inflammatory medications or steroid injections into the tarsal tunnel in order to reduce swelling  and relieve pressure of the posterior tibial nerve. Moreover, antineuritic medications and occasionally tricyclic antidepresants may be used in order to improve the symptoms. Additionally, braces, walking boots and other orthopaedic devices may be recommended in order to limit the movements of the foot that could cause or aggravate the symptoms.

If the TTS is sever or resistant to the treatment (refractory TTS), the surgical release of the posterior tibial nerve is indicated. The operation is performed under the general anaesthesia. First, the surgeon makes a curved  8-10 cm  length incision in the medial malleolus area.

Then, the flexor retinaculum is identified and separated from the underlying structures. The surgeon divides the flexor retinaculum and releases the posterior tibial nerve.

Complications

A recurrent compression of the nerve can occur relating to the postoperative scar tissue. Moreover, the branches of the posterior tibial nerve may be injured during the surgery. In some cases wound dehiscence and hematoma formation can occur.