What Is Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome is a compression on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot. That narrow path is called the tarsal tunnel. The tunnel is covered with a thick ligament that protects and maintains the structures contained within the tunnel—arteries, veins, tendons and nerves. One of these structures is the posterior tibial nerve.
Tarsal tunnel syndrome is caused by anything that produces the compression listed above:
- A flat-footed person 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 or 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.
- Systemic diseases, such as diabetes or arthritis, can cause swelling, which compresses the nerve.
Patients with tarsal tunnel syndrome experience one or more of the following symptoms:
- Tingling, burning or a sensation similar to an electrical shock
- Pain, including shooting pain
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 or the calf. Symptoms are often brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising or beginning a new exercise program. If left untreated and the condition progresses it 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 a correct diagnosis can be made and appropriate treatment initiated.
Diagnosis & Treatment
Advanced imaging studies may be ordered if a mass is suspected or if initial treatment does not reduce the symptoms. Studies used to evaluate nerve problems—electromyography and nerve conduction velocity (EMG/NCV)—may be ordered if the condition shows no improvement with nonsurgical treatment.
Many treatment options, often used in combination, are available to treat tarsal tunnel syndrome. These include:
Rest. Staying off the foot prevents further injury and encourages healing.
Ice. Apply an ice pack to the affected area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
Oral medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
Immobilization. Restricting movement of the foot by wearing a cast is sometimes necessary to enable the nerve and surrounding tissue to heal.
Physical therapy. Ultrasound therapy, exercises and other physical therapy modalities may be prescribed to reduce symptoms.
Injection therapy. Injections of a local anesthetic provide pain relief, and an injected corticosteroid may be useful in treating the inflammation.
Orthotic devices. Custom shoe inserts may be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve.
Shoes. Supportive shoes may be recommended.
Bracing. Patients with flat fleet or those with severe symptoms and nerve damage may be fitted with a brace to reduce the amount of pressure on the foot.
When Is Surgery Needed?
Sometimes surgery is the best option for treating tarsal tunnel syndrome. We can determine if surgery is necessary and will select the appropriate procedure or procedures based on the cause of the condition.