What is tarsal tunnel syndrome?
Tarsal tunnel syndrome is a condition caused by repeated pressure that results in damage on the posterior tibial nerve. Your tibial nerve branches off of the sciatic nerve and is found near your ankle.
The tibial nerve runs through the tarsal tunnel, which is a narrow passageway inside your ankle that is bound by bone and soft tissue. Damage of the tibial nerve typically occurs when the nerve is compressed as a result of consistent pressure.
People with tarsal tunnel syndrome may experience pain, numbness, or tingling. This pain can be felt anywhere along the tibial nerve, but it’s also common to feel pain in the sole of the foot or inside the ankle. This can feel like:
- sharp, shooting pains
- pins and needles
- an electric shock
- a burning sensation
Symptoms vary greatly depending on each individual. Some people experience symptoms that progress gradually, and some experience symptoms that begin very suddenly.
Pain and other symptoms are often aggravated by physical activity. But if the condition is long-standing, some people even experience pain or tingling at night or when resting.
Tarsal tunnel syndrome results from compression of the tibial nerve, and it’s often caused by other conditions.
Causes can include:
- severely flat feet, because flattened feet can stretch the tibial nerve
- benign bony growths in the tarsal tunnel
- varicose veins in the membrane surrounding the tibial nerve, which cause compression on the nerve
- inflammation from arthritis
- lesions and masses like tumors or lipomas near the tibial nerve
- injuries or trauma, like an ankle sprain or fracture — inflammation and swelling from which lead to tarsal tunnel syndrome
- diabetes, which makes the nerve more vulnerable to compression
If you think you have tarsal tunnel syndrome, you should see your doctor so they can help you identify the cause and create a treatment plan so that the condition doesn’t get worse. Your general practitioner can refer you to an orthopedic surgeon or podiatrist.
At your appointment, your doctor will ask about the progression of your symptoms and about medical history like trauma to the area. They’ll examine your foot and ankle, looking for physical characteristics that could indicate tarsal tunnel syndrome. They’ll likely perform a Tinel’s test, which involves gently tapping the tibial nerve. If you experience a tingling sensation or pain as a result of that pressure, this indicates tarsal tunnel syndrome.
Your doctor may also order additional tests to look for an underlying cause, including an electromyography, which is a test that can detect nerve dysfunction. MRIs may also be ordered if your doctor suspects that a mass or bony growth could be causing the tarsal tunnel syndrome.
If tarsal tunnel syndrome is left untreated, it can result in permanent and irreversible nerve damage. Because this nerve damage affects your foot, it could be painful or difficult to walk or resume normal activities.
Treating tarsal tunnel syndrome depends on your symptoms and the underlying cause of your pain.
You can take anti-inflammatory medications (including nonsteroidal anti-inflammatory drugs) to reduce inflammation, which may alleviate compression of the nerve. Resting, icing, compression, and elevation, known as the RICE treatment, may also help reduce swelling and inflammation.
Steroid injections may also be applied to the affected area to reduce swelling. In some cases, braces and splits may be used to immobilize the foot and limit movement that could compress the nerve. If you have naturally flat feet, you may want to have custom shoes made that support the arches of your feet.
In severe, long-term cases, your doctor may recommend a surgery called the tarsal tunnel release. During this procedure, your surgeon will make an incision from behind your ankle down to the arch of your foot. They will release the ligament, relieving the nerve.
A minimally invasive surgery is also used by some surgeons, in which much smaller incisions are made inside your ankle. The surgeon uses tiny instruments to stretch out the ligament. Because there’s less trauma sustained by the tissues, the risk of complications and recovery time are both reduced.
Tarsal tunnel syndrome can be managed or cured with a wide variety of treatment options, but regardless of what the underlying condition is, it’s essential to get early treatment to prevent permanent nerve damage.