Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is a painful condition of the foot caused by pressure on the posterior tibial nerve as it passes along a passage called the tarsal tunnel just below the bony bit on the inside of the ankle.

 Tarsal tunnel symptoms

Tarsal tunnel syndrome symptoms include pain which is often described as a burning pain which radiates into the arch of the foot, heel and sometimes the toes. Pins and needles or numbness may be felt in the sole of the foot. Pain may be worse when running or when standing for long periods of time. Tarsal tunnel syndrome pain is often worse at night and relieved by rest.

Tinels test

Tinnels test for tarsal tunnel syndromeA professional therapist may use tinels test to diagnose tarsal tunnel syndrome. This involves tapping the nerve just behind the medial malleolus or bony bit of the ankle with a rubber hammer. The test is positive if the tapping reproduces pain. The area under the medial malleolus may be tender to touch.

The symptoms of tarsal tunnel syndrome may initially be mistaken for plantar fasciitis which also causes pain from the medial heel and throughout the arch of the foot. Neural symptoms (such as tingling or numbness) as well as the location of tenderness when touching the area should help to easily distinguish between the conditions.

Tarsel tunnel syndrome explained

Over pronationTarsal tunnel syndrome is an entrapment or compression of the posterior tibial nerve which passes down the inside of the ankle. If you overpronate or your foot rolls in when you walk or run as shown then pressure is put on the nerve which can become inflamed resulting in tarsal tunnel syndrome. Because the condition is often due to overpronation, it is common for tarsal tunnel syndrome to occur in both feet at the same time.

The term anterior tarsal tunnel syndrome is sometimes applied to a rare entrapment of the deep peroneal nerve at the front of the ankle, although this is not strictly the same as tarsal tunnel syndrome. Symptoms appear on the top of the foot and radiate towards the 1st and 2nd toes.

What causes tarsal tunnel syndrome?

Tarsal tunnel syndrome can be both idiopathic - meaning it occurs spontaneously - or can be associated with a traumatic injury.

In people involved in running or running based sports, where the condition occurs spontaneously, then overpronation is the most frequent cause.

Tarsal tunnel syndrome treatment

What can the athlete do about tarsal tunnel syndrome?

Calf stretchingRest from any aggravating activities and apply cold therapy whilst in the acute when the foot or ankle is painful and inflamed. Your Doctor may prescribe anti-inflammatory medication to help reduce pain and inflammation.

Once the initial pain and inflammation has gone then a full rehabilitation program which includes stretching and strengthening exercises for the foot can begin. If you suspect you over pronation see a foot specialist, podiatrist or physiotherapist who can assess this.

What might an injury specialist do?

Foot injection should show to inside of foot not outsideNerve conduction studies may be undertaken to confirm the diagnosis and indicate the location of the entrapment. An X-ray or MRI may also be useful to determine the presence of any other structures such as cysts, arthritis or a tarsal coalition.

If conservative treatment fails then a corticosteroid injection may be administered. For stubborn and persistent cases surgery may be required to decompress the nerve.

Tarsal tunnel syndrome surgery

Surgery may be undertaken if conservative treatment has failed. The operation is undertaken to decompress the nerve by freeing the soft tissue structures in the area, creating more space for the nerve.

The success rate from tarsal tunnel syndrome surgery is mixed, with a high risk of complications. The procedure itself is very fast, although a complete recovery can take anywhere from a couple of weeks to a few months.