Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome, also known as TTS or posterior tibial neuralgia, results from the compression of the tibial nerve as it travels through an area called the tarsal tunnel. The squeezing of the nerve through this narrow passageway results in symptoms along the path of the nerve from the inside of the ankle to the foot. This area, bound by bone and soft tissue, may provide prolonged or consistent pressure on the nerve. Over time, this pressure may cause a “pins and needles” feeling, burning sensation, or shooting pains.

A gradual progression of symptoms may occur, but in some patients the symptoms have a sudden onset.

If tarsal tunnel syndrome sounds like carpal tunnel syndrome, that shouldn’t be surprising. The causes and symptoms of both conditions are similar – burning or shooting sensations resulting from nerve compression in a narrow passageway. Carpal tunnel occurs in the wrist while tarsal tunnel occurs in the foot.

What causes tarsal tunnel syndrome?

Flat-footed people may be at a greater risk of tarsal tunnel. Fallen arches can stress the tibial nerve and cause compression. Bony growths in the tarsal tunnel may also impact the nerve causing symptoms to arise. Varicose veins, arthritis, diabetes and acute injuries like ankle sprains or fractures may also cause a sudden or gradual compression.

An orthopaedic foot and ankle specialist will help you identify the cause of your symptoms and develop a treatment plan that is right for you. The history of your symptoms and progression of the condition will play an important role in appropriately diagnosing the problem. A gentle tapping of the tibial nerve, called a Tinel’s test, may help confirm TTS. Other images or tests, such as MRI or electromyography, may help detect nerve dysfunction or growth within the tunnel that causes the compression.

What should I do if I have tarsal tunnel?

If you suffer from any of these symptoms, consult with a physician immediately. As is the case with other nerve problems in other areas of the body, long-term nerve compression may result in irreversible damage that could affect your quality of life or ability to walk normally.

A foot and ankle doctor may prescribe NSAID medications or localized steroid injections to reduce swelling and discomfort. Custom orthotics or arches may help patients with flat feet. For more severe cases, a surgeon may make a small incision from behind your ankle down to the arch of your foot to release the ligament and relieve the compression of the nerve. For less severe cases, a home program including rest, ice, compression and elevation, as well as shoe or behavior modification, may help symptoms.