TARSAL TUNNEL SYNDROME

What Is the Tarsal Tunnel?

In the narrow space on the inside of the ankle next to the ankle bones, lies a tunnel covered with a thick ligament that protects and maintains the arteries, veins, tendons, and nerves inside the tunnel. 

What Is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome describes a compression, or squeezing, on the Posterior Tibial Nerve inside the Tarsal Tunnel. Compressing the Posterior Tibial Nerve produces symptoms anywhere along the path of the nerve running down the inside of the ankle along the foot.

Tarsal tunnel syndrome bears many similarities to carpal tunnel syndrome, which occurs under similar circumstances in the wrist. 

Causes of Tarsal Tunnel Syndrome

Anything that causes an increase in pressure on the posterior tibial nerve can lead to Tarsal tunnel syndrome, such as:

  • The outward tilt of someone with flat feet or fallen arches can produce strain and compression on the nerve.
  • ¬†Varicose veins, ganglion cyst, swollen tendons, and arthritic bone spurs can occupy space within the Tarsal Tunnel and compress the nerve.
  • Injuries, such as ankle sprains, may cause inflammation and swelling around the tunnel, which can compress the nerve.
  • Other systemic diseases such as arthritis or diabetes can also cause swelling.

Symptoms of Tarsal Tunnel Syndrome

Patients with tarsal tunnel syndrome usually experience some of the following in the ankle and foot:

  • Burning, tingling, or buzzing sensation
  • Numbness
  • Pain, shooting down into the foot

Patients commonly report symptoms on the inside of the ankle and on the bottom of the foot. Symptoms may sometimes only occur in one area, and sometimes extend to the heel, arch, toes, and the calf.

Sometimes symptoms of Tarsal Tunnel Syndrome can appear suddenly, but often occur due to general overuse of the foot, such as prolonged standing, walking, exercising, or beginning a new exercise program.

Patients should seek early treatment if they experience any of the symptoms of tarsal tunnel syndrome. If left untreated, the condition can progress and result in permanent nerve damage. In addition, since the symptoms of tarsal tunnel syndrome can seem similar to other ankle conditions, only a physician can give a proper evaluation to correctly diagnose the condition.

Non-surgical Treatment of Tarsal Tunnel Syndrome

Before considering surgery, Foot and Ankle Specialists will usually attempt conservative treatments, including:

  • Rest. Staying off the foot allows it to heal.
  • Ice. Apply a cold pack wrapped in a thin towel to the affected ankle. Apply for 20 minutes and then wait 40 minutes before applying it again.
  • Oral Pain-killers. Nonsteroidal anti-inflammatory drugs such as ibuprofen, can help reduce inflammation and pain.
  • Physical therapy. Your physician may prescribe certain exercises or other physical therapy modalities to help reduce symptoms.
  • Injections. Injections of local anesthetic can provide pain relief, and corticosteroid injections help treat inflammation.
  • Orthotics. Custom shoe inserts may help maintain the arch of the foot and limit excessive motion causing the compression of the nerve.
  • Braces. Patients with flatfoot or severe symptoms and nerve damage may need to wear a brace to reduce the pressure on the foot.

When is Surgery Needed For Tarsal Tunnel Syndrome?

Sometimes Tarsal Tunnel Syndrome will end up requiring surgery. The foot and ankle specialist will determine if surgery is necessary and will select the appropriate procedure based on the source of the condition.