Tarsal Tunnel Syndrome

Tarsal tunnel syndrome pain location

Tarsal tunnel syndrome causes burning pain in the foot, sometimes with pins and needles or numbness. Pain may radiate into the heel and arch of the foot. It is caused by pressure on a nerve which passes along the inside of the ankle.

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Tarsal Tunnel Syndrome Symptoms

  • Symptoms include pain, which is often described as burning pain, that 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 standing for long periods of time and will often be worse at night.

Tinel’s test

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The area under the medial malleolus on the inside of the ankle may be tender to touch. A professional therapist may use tinels test to diagnose tarsal tunnel syndrome. This involves tapping the nerve just behind the medial malleolus (the bony bit on the inside of the ankle) with a rubber hammer. Pain indicates a positive test.

Sometimes it is initially mistaken for plantar fasciitis which also causes pain from the inside 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.

Nerve conduction studies may be done to confirm the diagnosis, however, in 50% of cases these are negative.


What is Tarsal tunnel syndrome?

Tarsal tunnel nerce compression

Tarsal tunnel syndrome occurs when the posterior tibial nerve which passes down the inside of the ankle becomes compressed or trapped. The nerve passes along a passage called the tarsal tunnel, just below the medial malleolus.

If you overpronate (where your foot rolls or flattens) when you walk or run then this can contribute to the compression of the nerve. Because overpronation is a key factor, it is common for the problem to occur in both feet at the same time. Where the condition occurs spontaneously in people involved in running or running based sports, then overpronation is the most frequent cause.

The term anterior tarsal tunnel syndrome is sometimes applied to a rare entrapment of the deep peroneal nerve at the front of the ankle. However, this is not strictly the same as 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 for apparently no reason, or it can be associated with a traumatic injury.

Causes include:

  • Osteoarthritis at the ankle joint – possibly as a result of an old injury
  • Rheumatoid arthritis
  • Diabetes
  • Overpronation
  • Tenosynovitis
  • Talonavicular coalition – fusing of two of the tarsal bones.
  • A cyst or ganglion in the tarsal tunnel.

Tarsal Tunnel Syndrome Treatment

The aim of tarsal tunnel syndrome rehabilitation is:

  • Reduce pain and inflammation.
  • Correct any biomechanical dysfunction such as overpronation.
  • Stretching & strengthening exercises.
  • A gradual return to full fitness.

What can the athlete do?

Cold wrap

Rest from any aggravating activities and apply the PRICE principles of protection, rest, ice, compression, and elevation. Apply cold therapy in the acute phase 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 have gone then a full rehabilitation program which includes stretching exercises and strengthening exercises for the foot can begin.

Stretching exercises may include stretching for the calf muscles (gastrocnemius and soleus) as well as the plantar fascia under the foot. Strengthening exercises are similar to that of an ankle sprain but may focus more on inversion strengthening or strengthening as the foot turns inwards.

Consult a foot specialist, podiatrist or physiotherapist who can assess this and biomechanical problems of the foot.

What can a sports injury professional do?

A professional therapist or doctor can accurately diagnose the injury and establish any possible causes. Nerve conduction studies may be done 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. The operation aims to decompress the nerve by freeing the soft tissue structures in the area, creating more space for the nerve.

Surgery may be indicated when the diagnosis is definite and if the athlete has endured several months of problems without a response to the conservative treatment above. The success rate from surgery is mixed, with a high risk of complications. The procedure itself is very fast, although complete recovery can take anywhere from a couple of weeks to a few months.


Exercises

Both stretching and strengthening exercises are important for treating Tarsal tunnel syndrome. In particular, stretching the calf muscles and strengthening the Tibialis posterior muscles are important.

Read more on Tarsal tunnel syndrome exercises.


References & further reading

This article has been written with reference to the bibliography.