Tarsal Tunnel syndrome
The tarsal tunnel is a narrow space that lies on the inside of the
ankle next to the ankle bones. The tunnel is covered with a thick ligament (the
flexor retinaculum) that protects and maintains the structures contained within
the tunnel—arteries, veins, tendons, and nerves. One of these structures is the
posterior tibial nerve, which is the focus of tarsal tunnel syndrome.
Tarsal tunnel syndrome is a compression, or squeezing, on the
posterior tibial nerve that produces symptoms anywhere along the path of the
nerve. The posterior tibial nerve runs along the inside of the ankle into the
Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which
occurs in the wrist. Both disorders arise from the compression of a nerve in a
confined space.Although tarsal tunnel syndrome may not be as well known as
carpal tunnel syndrome, it is nevertheless a cause of foot and ankle pain in
Patients with tarsal tunnel syndrome experience one or more of the
Tingling, burning, or a sensation
similar to an electrical shock
Pain, including shooting pain
The symptoms are typically felt on the inside of the ankle and/or on
the bottom of the foot. In some people, a symptom may be isolated and occur in
just one spot. In others, it may extend to the heel, arch, toes, and even the
Sometimes the symptoms of the syndrome appear suddenly. Often they
are brought on or aggravated by overuse of the foot—such as in prolonged
standing, walking, exercising, or beginning a new exercise program.
It is very important to seek early treatment if any of the symptoms
of tarsal tunnel syndrome occur. If left untreated, the condition progresses
and may result in permanent nerve damage. In addition, because the symptoms of
tarsal tunnel syndrome can be confused with other conditions, proper evaluation
is essential so that correct diagnosis can be made.
Tarsal tunnel syndrome is caused by anything that produces
compression on the posterior tibial nerve, such as:
A person with flat feet is at risk for developing tarsal tunnel
syndrome, because the outward tilting of the heel that occurs with “fallen
arches" can produce strain and compression on the nerve.
An enlarged or abnormal structure that occupies space within the
tunnel can compress the nerve. Some examples include a varicose
vein, ganglion cyst, swollen tendon, and arthritic bone spur.
An injury, such as an ankle sprain, may produce inflammation and
swelling in or near the tunnel, resulting in compression of the nerve.
A person who is overweight may be prone to experiencing pressure
on the posterior tibial nerve.
Systemic diseases such as diabetes or arthritis can cause swelling,
thus compressing the nerve.
The doctor at A+ clinic foot will examine the foot to arrive at a
diagnosis and determine if there is any loss of feeling. During this
examination, the surgeon will position the foot and tap on the nerve to see if
the symptoms can be reproduced. He or she will also press on the area to help
determine if a small mass is present.
Sometimes an MRI is ordered, usually if a mass is suspected or in
cases where initial treatment does not reduce the symptoms. In addition,
special studies used to evaluate nerve problems—electromyography and nerve
conduction velocity (EMG/NCV)—may be ordered if the condition shows no
improvement with non-surgical treatment.
A variety of treatment options, often used in combination, are
available to treat tarsal tunnel syndrome.
Staying off the foot prevents further injury and encourages healing.
To reduce swelling in the tarsal tunnel, apply a bag of ice over a thin towel
to the affected area for 20 minutes of each waking hour. Do not put ice
directly against the skin.
Nonsteroidal anti-inflammatory drugs (NSAIDs),such as ibuprofen,
help reduce the pain and inflammation.
Restricting movement of the foot by wearing a cast is sometimes necessary to
enable the nerve and surrounding tissue to heal.
Ultrasound therapy, exercises, and other forms of physical therapy may be
prescribed to reduce symptoms.
Injections of a local anesthetic provide pain relief, and an injected
corticosteroid may be useful in treating
Orthotic devices. Custom
shoe inserts may be prescribed to help maintain the arch and limit excessive
motion that can cause compression on the nerve.
Supportive shoes, as recommended by your foot and ankle surgeon, may prove
Patients with flatfoot or those with severe symptoms and nerve damage may be
fitted with a brace to reduce the amount of
pressure on the foot.
Sometimes surgery is the best option for treating tarsal tunnel syndrome. The
doctor at A+ clinic will determine if surgery is necessary and will select the
appropriate procedure or procedures based on the cause of the condition.