What Is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is like carpal tunnel syndrome but in your feet.  Tarsal tunnel happens when repeated pressure causes damage to your posterior tibial nerve.  The tibial nerve branches off from your sciatic nerve, located right behind your knee, and can be found in your ankle.  The nerve runs through the tarsal tunnel on the inside of your foot surrounded by bone and soft tissue.  When you have constant pressure on this area of the foot, you might experience symptoms of Tarsal Tunnel Syndrome.  

There are a few things that might cause a tarsal tunnel syndrome to flare up, but first, you should know what symptoms to look for with this syndrome.

What Are the Symptoms of Tarsal Tunnel?

There are a few different symptoms you might experience with tarsal tunnel syndrome.  The first most common complaints are sharp shooting pains starting in the ankle and then radiating out towards your heel and the arch of your foot.  Some also describe this pain as a burning sensation.  

It might also feel like walking on pins and needles as you move.  Again, this sensation stays around the ankle and the arch of your foot.  A few people say the pain almost feels like an electric shock each time the take a step.  Other common symptoms of tarsal tunnel include:

  • Tingling
  • Excessive pain
  • Swelling
  • Numbness
  • Burning starting at the heel and traveling up the calf

The symptoms will vary significantly from patient to patient, and you might not necessarily feel all of this.  It depends on how long the compression of the tibial nerve has occurred and the location of the compression.

Some people only feel pain as they walk or do some other type of activity.  Others can feel a constant pain which is usually an indication that the problem has been going on for a while.  

What Causes Tarsal Tunnel?

Numerous things could potentially cause tarsal tunnel syndrome.  There are two types of tarsal tunnel, idiopathic or due to an activity.   Idiopathic tarsal tunnel syndrome occurs spontaneously with no explanation.

It’s more common to see tarsal tunnel syndrome in someone who has had a previous ankle injury or who is involved in sports.  Runners tend to have higher rates of tarsal tunnel due to overpronation.  Pronation is the natural way our foot moves as we walk or run.  Someone who overpronates rolls their foot in towards the arch more than usual as they walk or run.  Over or excessive pronation can cause pressure on the tibial nerve and lead to tarsal tunnel syndrome.

People who have flatter feet are also more susceptible to tarsal tunnel.  Because the arch of their foot is closer to the ground, they have a better chance of putting unnecessary pressure on their tibial nerve.  Some people tend to have bony growths on their tibia, and that can put pressure on the nerve and cause pain.  Varicose veins are another condition that might cause tarsal tunnel pain.  Varicose veins only cause problems if they are in the membrane surrounding the nerve, not if they are in other spots on the leg.

People who have arthritis might also have issues with tarsal tunnel syndrome because inflammation can press on the tibial nerve.  Diabetics are also often prone to tarsal tunnel issues because their nerves are more susceptible to inflammation and compression.

Any athlete who has had a previous ankle or foot injury should also be aware of tarsal tunnel syndrome.  Fractures, breaks, and sprains will cause inflammation right around the tarsal tunnel and could contribute to pressure on the tibial nerve.  In very few cases, tarsal tunnel pain could be caused by lesions or tumors on the tibial nerve.  

How Does Tarsal Tunnel Syndrome Get Diagnosed?

If you notice you have nagging pain in your foot that matches the symptoms above, you should visit your doctor.  Typically, if you have been having pain for longer than a few days, you should seek professional advice.  Your primary care doctor should be able to get you a referral to an orthopedic surgeon or podiatrist.  A physical therapist might also be able to get you in to see one of these experts.

Once you get to the doctor, they will take a medical history to see if you could have conditions such as arthritis or diabetes.  Then they will ask about what you might have done in the past few days that could contribute to your foot pain.  Athletes should try to recount all practice and games to see if there might have been an injury.  

After they get a complete history, the doctor will do a physical examination on your foot.  They might move it back and forth to see which movement hurts most and to check for swelling.  They will also perform a Tinel’s test, which is merely tapping the tibial nerve.   If there is pain while they do that, most likely you have tarsal tunnel syndrome.  

The doctor might also decide to order additional testing if they think the damage is more extensive or if you have had this issue for a long time.  These tests might include an electromyography to detect nerve function or an MRI to see if you have a mass or bony growth affecting the area.  Not every case will need these additional tests.  

It’s important to go to the doctor as soon as possible if you suspect something is wrong with your foot or the tarsal tunnel.  The longer tarsal tunnel syndrome is left undiagnosed, the higher chance you have of permanent nerve damage.  Once a nerve is permanently damaged, there isn’t much you can do to restore normal function.  Early detection of tarsal tunnel is best because it’s is a relatively simple problem to treat.

What Are the Treatments for Tarsal Tunnel?

There are a few treatments you can implement to help tarsal tunnel syndrome.  Your treatment will depend on the extent of the damage and if you have any other issues.

At-Home Treatments

Most often you will be sent home with a few things to do to help heal tarsal tunnel syndrome.  You can take over the counter pain medication to help with inflammation and pain.  These drugs might also help ease any pressure on the tibial nerve.  Your doctor might also tell you to use the RICE treatment.  This treatment includes resting, icing, compression, and elevation.  Your doctor will show you how to  do all those correctly, so you don’t further damage the area.

Athletes might also benefit from seeing a physical therapist, especially if there is an issue of over or excessive pronation.  A therapist can help you correct your gait and give you exercises to heal and strengthen the area.  

Prescribed Treatments

If the pain is bad or inflammation extreme, your doctor might give you a steroid injection.  This injection can help calm swelling quickly and remove any compression on the tibial nerve.  You might also have to wear a splint or boot for a time to help keep the foot from moving.  Some movements put more pressure on your tibial nerve, and you need to immobilize your foot for a bit to heal the inflammation.  For those patients with flat feet, you might need to order special shoes to support your arch and remove tibial pressure.  

Medical Procedures

In extreme cases, your doctor might prescribe tarsal tunnel surgery.  Surgery is usually only needed if the issue has been long-term or there is severe damage.  Two procedures could relieve the pain of tarsal tunnel syndrome.  

In the first procedure, a surgeon will make an incision behind your ankle down to the arch of your foot.  From there they will release the ligament and remove the compression on the nerve.  Another procedure uses small incisions around the ankle where the surgeon will insert tiny tools to stretch the ligament and release any pressure.  

You might also need surgery if there are masses or lesions around or on the tibial nerve.  If there are masses, a biopsy might be performed to see if they are benign or malignant.  No matter what, the surgeon will do the best they can to remove all lesions or masses to relieve pressure on the tibial nerve.

Most of these procedures are minimally invasive and shouldn’t take long to perform.  As is the case for many surgeries, recovery time might take a few weeks to a few months.  During that time, you might need to wear a boot and perform physical therapy exercises to rebuild the strength in the ankle.  

Outlook for Tarsal Tunnel Syndrome

Overall, tarsal tunnel syndrome is typically not a serious issue, especially if caught early on.  The sooner you go to see a doctor after you start having foot pain, the better off you will be.  The longer you wait, the more damage your nerve might sustain, and it could lead to permanent problems.  For most patients, a little extra care and attention will solve the problem and get them back on their feet.  

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