Tarsal Tunnel Syndrome: Causes, Symptoms, Treatment, and Rehabilitation

What is Tarsal Tunnel Syndrome?

Tarsal Tunnel Syndrome occurs when the posterior tibial nerve, which runs from the back of the leg into the foot, becomes compressed or irritated as it passes through the tarsal tunnel, a narrow passageway on the inside of the ankle. The compression of this nerve leads to various symptoms that can affect the ankle, foot, and even the lower leg.

The condition is similar to carpal tunnel syndrome, but instead of affecting the wrist, it affects the ankle and foot.

Causes of Tarsal Tunnel Syndrome

Several factors can contribute to the development of Tarsal Tunnel Syndrome, including:

• Trauma or Injury: Direct injury or trauma to the ankle or foot, such as sprains or fractures, can increase the likelihood of nerve compression.

• Ankle Abnormalities: Structural issues, such as flat feet or high arches, can change the alignment of the foot, putting pressure on the posterior tibial nerve.

• Swelling or Inflammation: Conditions like arthritis, diabetes, or cysts can lead to swelling and inflammation around the tarsal tunnel, causing nerve compression.

• Overuse: Repetitive movements or overuse of the foot and ankle during high-impact activities, such as running, can lead to irritation and compression of the nerve.

• Nerve Entrapment: Abnormalities such as tumors or cysts in the tarsal tunnel can directly press on the posterior tibial nerve.

Symptoms of Tarsal Tunnel Syndrome

The symptoms of Tarsal Tunnel Syndrome typically involve pain, numbness, tingling, and weakness along the foot and ankle. These symptoms often become worse with activity or prolonged standing and may include:

• Pain: A dull, aching pain along the inside of the ankle and foot, which may radiate to the toes.

• Tingling or Numbness: A "pins and needles" sensation or loss of feeling along the bottom of the foot, especially near the toes.

• Burning Sensation: A burning or electric shock-like feeling along the foot and ankle.

• Weakness: Weakness in the foot, making it difficult to flex or push off when walking.

• Aggravation with Activity: Symptoms often worsen after standing, walking, or running for prolonged periods.

Symptoms of Tarsal Tunnel Syndrome may vary from mild to severe and can significantly affect daily activities and quality of life.

Diagnosis of Tarsal Tunnel Syndrome

To diagnose Tarsal Tunnel Syndrome, healthcare providers typically perform a thorough physical examination, ask about the patient’s medical history, and may conduct specific tests to assess nerve function. Diagnostic tests may include:

Clinical Examination:

• Tinel’s Sign: Tapping on the tarsal tunnel area to see if it produces tingling or pain along the nerve pathway, which is a positive indicator of TTS.

• Nerve Conduction Studies: These tests assess how well electrical impulses travel along the nerve, which can confirm if there is nerve compression.

• MRI or Ultrasound: Imaging tests can be used to identify any structural abnormalities, such as cysts or swelling, that may be contributing to the compression.

Treatment for Tarsal Tunnel Syndrome

Treatment for Tarsal Tunnel Syndrome can range from conservative, non-invasive approaches to surgical intervention, depending on the severity of the condition and the patient's response to therapy.

Non-Surgical Treatment:

• Physiotherapy: Physiotherapy plays a key role in treating TTS. Treatment may include:

  • Stretching and Strengthening Exercises: Targeting the muscles around the ankle and foot to improve flexibility and support the nerve.

  • Manual Therapy: Techniques like soft tissue mobilization or joint manipulation may help relieve tension and improve circulation around the tarsal tunnel.

  • Nerve Gliding Exercises: Special exercises designed to help the nerve move freely within the tunnel and reduce compression.

• Rest and Ice: Resting the affected foot and ankle, along with applying ice, can help reduce inflammation and swelling.

• Bracing or Splinting: Wearing a brace or splint to immobilize the foot and prevent further compression of the nerve.

• Orthotics: Custom-made or over-the-counter insoles can help correct foot alignment, alleviate pressure on the nerve, and reduce symptoms.

• Anti-Inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.

Surgical Treatment:

If conservative treatments do not provide relief, surgery may be necessary to release the pressure on the posterior tibial nerve. Surgical options may include:

• Tarsal Tunnel Release Surgery: This procedure involves cutting through the ligament that is pressing on the nerve, which helps to relieve the compression and alleviate symptoms.

• Removal of Tumors or Cysts: If the nerve is being compressed by a cyst or tumor, surgical removal of the growth can provide relief.

Rehabilitation at Palms Physiotherapy & Allied Health

Rehabilitation is an important aspect of treatment for Tarsal Tunnel Syndrome. Our expert physiotherapists will develop a personalized rehabilitation program that may include:

• Pain Management: Techniques like cold therapy, massage, and electrotherapy to manage pain and swelling.

• Strengthening Exercises: Exercises to strengthen the muscles around the ankle and foot to support the healing process and reduce future nerve compression.

• Stretching and Mobility: Focus on increasing the flexibility of the foot and ankle to reduce pressure on the posterior tibial nerve.

• Footwear Advice: Recommendations on footwear and orthotics to improve foot alignment and reduce stress on the nerve.

Our goal is to restore function, alleviate pain, and improve your quality of life.

Preventing Tarsal Tunnel Syndrome

While some causes of Tarsal Tunnel Syndrome are unavoidable, there are steps you can take to reduce the risk of developing the condition or experiencing a recurrence:

• Proper Footwear: Wearing shoes with good arch support and cushioning can help reduce pressure on the tarsal tunnel.

• Avoid Overuse: Limit activities that require excessive pressure or strain on the foot and ankle.

• Stretching and Strengthening: Incorporate stretching and strengthening exercises into your routine to maintain proper flexibility and muscle strength around the foot and ankle.

• Manage Underlying Conditions: Conditions like diabetes or arthritis can increase the risk of developing TTS, so managing these conditions may help prevent nerve compression.

Tarsal Tunnel Syndrome is a manageable condition with the right treatment and rehabilitation. If you're experiencing symptoms of TTS, don’t hesitate to contact Palms Physiotherapy & Allied Health to receive personalized care and support to help relieve pain and improve your ankle and foot function.