Tarsal Tunnel Syndrome

Tarsal tunnel syndrome (TTS) describes the painful entrapment/compression of a nerve (called the tibial nerve) as it passes through a narrow tunnel on the inside of the ankle (called the tarsal tunnel) which is created by the position of the bones and connective tissue.

Anatomy

The tarsal tunnel is located just below the bony bump (medial malleolus) on the inside of the ankle, towards the back of the heel. It is a channel for tendons, arteries and nerves to pass through, and is secured by a connective tissue sheath called the flexor retinaculum that covers the top of the channel.

The tibial nerve, one of the nerves that provides sensation to the feet, passes through this tunnel and splits into two branches - the medial and lateral plantar nerves.

What causes tarsal tunnel syndrome?

Sometimes, tarsal tunnel syndrome can have no specific cause. Usually, however, it can be attributed to one or more of the following:

• Repetitive impact activities such as running
• Ankle injury
• Abnormal foot alignment or position
• Inflamation of structures within the tarsal tunnel
• Abnormal growth or cyst within the tunnel
• Tarsal coalition
• Inflamation from systematic conditions such as arthritis or diabetes

What are the symptoms?

On the inside of the ankle, as well as the heel and buttom of the foot, those with TTS may experience:

• Pain
• Swelling
• Burning
• Tingling
• Numbness
• Pins and needles

Symptoms may be sudden or gradual, and are often aggravated by movement. Because the tibial nerve (and its branches) give sensation to the heel and the bottom of the foot, this is where neural symptoms (burning, tingling, numbness) are experienced. Pain can radiate into the arch and present as heel pain. Being able to pinpoint the symptomatic areas are helpful in identifying the point at which the nerve is compressed and help make treatment more precise.

How is it treated?

Initially, to manage the painful symptoms, we recommend resting and elevating the affected foot, as well as using ice and anti-inflammatories.

The treatment of tarsal tunnel syndrome involves treating the particular cause of the nerve compression. We conduct a thorough biomechanical examination to assess the function and characteristics of your feet and legs to deduce the likely causes of your TTS. Your treatment plan may include:

• Custom orthotics to increase space within the tarsal tunnel by altering the alignment of the foot, relieve pressure from the tibial nerve, and correct any misalignments that are causing the symptoms
• Assessing footwear to ensure it is keeping your foot in a good, stable and supported position that doesn’t cause the onset of TTS symptoms
• Physical therapy (stretching and strengthening) to rehabilitate the foot and its musculature
• Gait retraining to reduce irritation within the tarsal tunnele 
• Dry needling, mobilisation and/or massage to improve the motion and movement in the foot and ankle and reduce compression within the tarsal tunnel during gait

Because permanent nerve damage can occur if proper care is not taken, it is important to seek treatment if you suspect you may have tarsal tunnel syndrome.