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.

Do you have or feel any of these symptoms?

• Tingling, burning, or a sensation similar to an electrical shock
• Numbness
• 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, and even the calf.

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.

What is Tarsal tunnel?

Tarsal tunnel syndrome is a compression, or squeezing, 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.

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.

Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, risk factors include:

• 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.
• Systemic diseases such as diabetes or arthritis can cause swelling, thus compressing the nerve.

Before you see a physician  

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 a correct diagnosis can be made and appropriate treatment initiated.

Reasons to see a physician and treatment options

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 a correct diagnosis can be made and appropriate treatment initiated.

A foot and ankle orthopedic surgeon could recommend a variety of treatment options to treat tarsal tunnel syndrome including:

Non-surgical treatment

• 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 –Nonsteroidal 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 flatfoot or those with severe symptoms and nerve damage may be fitted with a brace to reduce the amount of pressure on the foot.

Surgical treatment

Sometimes surgery is the best option for treating tarsal tunnel syndrome. The foot and ankle surgeon will determine if surgery is necessary and will select the appropriate procedure or procedures based on the cause of the condition.

In tarsal tunnel release, the surgeon creates an opening behind the ankle that extends down to the arch of the foot. The surgeon carefully divides the ligament so it is not pressing against the tibial nerve.

Anatomy

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. Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve