Tarsal Tunnel Syndrome: Causes & Symptoms

Introduction to Tarsal Tunnel

The tarsal tunnel is a narrow, confined space located on the inside of the ankle, formed by the flexor retinaculum and the underlying bones. This tunnel serves as a passageway for important structures, including the posterior tibial nerve, blood vessels, and tendons that supply the foot. When the posterior tibial nerve becomes compressed within this tight space, it can lead to tarsal tunnel syndrome symptoms such as foot and ankle pain, tingling, numbness, and a burning sensation in the plantar foot. Because the tarsal tunnel is so compact, even minor swelling or injury can put pressure on the nerve, resulting in significant discomfort and impaired nerve function. Understanding the anatomy of the tarsal tunnel and the role of the tibial nerve is essential for recognizing and addressing tunnel syndrome early, before pain and dysfunction worsen.

Understanding Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome (TTS) is a condition caused by the compression of the posterior tibial nerve as it travels through the tarsal tunnel, a narrow space inside the ankle. TTS is one of several entrapment neuropathies affecting the lower extremity, where nerves become compressed within confined anatomical spaces. TTS occurs when the tibial nerve is pinched or compressed within the tarsal tunnel, leading to pain, numbness, and tingling in the foot and ankle. Understanding the causes, symptoms, and treatment options is crucial for effective management [1].

Risk Factors for Tarsal Tunnel Syndrome

Several factors can increase the likelihood of developing tarsal tunnel syndrome. Individuals with flat feet or fallen arches are at higher risk, as abnormal foot mechanics can stretch and compress the tibial nerve. Overuse injuries from repetitive activities, such as running or prolonged standing, can also contribute to nerve compression. Previous trauma, including ankle sprains or fractures, may cause scar tissue or swelling that narrows the tarsal tunnel. Systemic diseases like diabetes and arthritis can lead to inflammation or soft tissue changes, further increasing the risk of nerve dysfunction. Additionally, anatomical variations, such as a naturally tight tarsal tunnel or the presence of space-occupying lesions like ganglion cysts or varicose veins, can predispose individuals to developing symptoms. Recognizing these risk factors is key to early diagnosis and prevention of further injury.

Causes of Tarsal Tunnel Syndrome and Tibial Nerve Involvement

• Flat feet or fallen arches
• Varicose veins or ganglion cysts
• Injury or trauma to the ankle
• Systemic diseases such as diabetes
• Repetitive stress or overuse
• Participation in sports or activities that involve sprinting, such as running, hockey, hiking, or ballet dancing

Identifying the underlying cause is essential for effective treatment and prevention of recurrence [2]. High levels of physical activity, especially those involving running or jumping, can increase the risk of developing tarsal tunnel syndrome.

Symptoms of Tarsal Tunnel Syndrome

• Pain and tingling in the foot and ankle
• Numbness in the sole of the foot
• Burning sensation in the foot
• Swelling in the ankle area
• Weakness in the foot muscles

Some patients may experience posterior tibial neuralgia, which is characterized by nerve pain along the course of the tibial nerve. Tibial nerve dysfunction can also result from prolonged compression, leading to persistent sensory or motor deficits.

Symptoms can vary in intensity and may worsen with prolonged standing or activity.

Diagnosis

Diagnosing tarsal tunnel syndrome involves a comprehensive evaluation, including:

• Medical history and physical examination
• Assessment of symptoms and nerve function
• Imaging studies (e.g., X-rays, MRI) to rule out other conditions
• Nerve conduction studies to assess nerve damage
• Checking for a positive Tinel sign over the tarsal tunnel

Accurate diagnosis is essential for developing an effective treatment plan [3]. Clinicians should assess for underlying medical conditions that may contribute to nerve symptoms. Plantar fasciitis should also be considered in the differential diagnosis, as it can present with similar symptoms.

Tarsal Coalition and Its Impact

Tarsal coalition is a condition where two or more bones in the foot are abnormally connected, either by bone, cartilage, or fibrous tissue. This abnormal connection can limit normal foot movement and alter the mechanics of the ankle, increasing stress on the tarsal tunnel area. As a result, the posterior tibial nerve may become compressed, leading to symptoms of tarsal tunnel syndrome such as foot and ankle pain, numbness, and tingling. Tarsal coalition can also contribute to the development of bone spurs or other space-occupying lesions, further narrowing the confined space of the tarsal tunnel. Early identification and management of tarsal coalition are important to reduce pressure on the nerve and prevent long-term complications.

Treatments for Tarsal Tunnel Syndrome

Initial treatment for tarsal tunnel syndrome typically includes rest, ice, and other conservative measures to reduce symptoms before considering advanced options.

Effective management of tarsal tunnel syndrome involves a combination of treatments tailored to the individual’s needs. Options include:

• Physical therapy: A physical therapist can design and supervise rehabilitation programs with exercises to strengthen the foot and ankle muscles and improve flexibility.
• Pain management: NSAIDs, corticosteroid injections, or topical analgesics.
• Orthotic devices: Custom shoe inserts to support the foot and reduce pressure on the nerve.
• Lifestyle modifications: Ergonomic adjustments and activity modification to reduce strain on the foot.
• Surgical intervention: In severe or refractory cases, foot and ankle surgery (foot ankle surg) may be necessary to relieve nerve compression.

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat tarsal tunnel syndrome.

Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with tarsal tunnel syndrome.

As prolotherapy is helping to treat the root cause of tarsal tunnel syndrome, it is deemed to be a permanent fix, preventing the symptoms from returning.

Nonsurgical Treatment Options

For many patients, nonsurgical treatment options can effectively reduce symptoms and improve quality of life. Physical therapy is often recommended to strengthen the foot and ankle muscles, improve flexibility, and restore normal movement patterns. Custom orthotics or shoe inserts can help support the arch, reduce pressure on the tibial nerve, and correct abnormal foot mechanics. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to reduce swelling and provide pain relief. Activity modification, such as avoiding prolonged standing or repetitive movements, can also help prevent further irritation of the nerve. Early intervention with these conservative measures can often prevent the need for surgery and minimize the risk of permanent nerve damage.

Advanced Treatments and Therapies

When nonsurgical treatments are not sufficient to relieve symptoms, advanced therapies may be considered. Tarsal tunnel release surgery is a procedure that involves relieving pressure on the posterior tibial nerve by cutting the flexor retinaculum and removing any space-occupying lesions, such as ganglion cysts or bone spurs. Steroid injections may be used to reduce inflammation and provide temporary pain relief in the tarsal tunnel area. Nerve conduction studies can help assess the extent of nerve damage and guide treatment decisions. In some cases, regenerative therapies such as prolotherapy or platelet-rich plasma (PRP) injections may be recommended to promote healing and restore nerve and muscle function. Addressing the underlying cause of nerve compression is essential to treat tarsal tunnel syndrome effectively and prevent complications if left untreated.

Case Study: Prolotherapy for Tarsal Tunnel Syndrome

Patient: Mark, 45, experienced chronic foot pain due to repetitive work activities.
Treatment: After limited relief from physical therapy and medications, Mark received a series of prolotherapy injections at ProHealth Clinic.
Outcome: Within three months, Mark reported a 70% reduction in pain and improved foot function, allowing him to return to work comfortably. His results were maintained at 12-month follow-up.

Frequently Asked Questions

What is the best treatment for tarsal tunnel syndrome?

A combination of physical therapy, lifestyle modifications, and prolotherapy is often recommended for tarsal tunnel syndrome. In severe cases, surgical intervention may be necessary.

Can tarsal tunnel syndrome be cured?

While some cases of tarsal tunnel syndrome can be resolved with treatment, others may require ongoing management. A combination of therapies can significantly improve symptoms and prevent recurrence.

How effective is prolotherapy for tarsal tunnel syndrome?

Clinical studies and patient experiences suggest prolotherapy can significantly reduce pain and improve function in tarsal tunnel syndrome, especially when other treatments have failed. It works by stimulating the body’s natural healing response and repairing damaged tissues [4].

How can I prevent tarsal tunnel syndrome from recurring?

Maintain good posture, use ergonomic tools, strengthen foot muscles, and avoid repetitive strain. Early intervention and regular exercise can help prevent recurrence.

Contact ProHealth Clinic Today for Your FREE 15-Minute Discovery Call

Don’t let tarsal tunnel syndrome control your life any longer. Join the thousands of patients who have found lasting relief through prolotherapy at ProHealth Clinic.

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Author Bio

Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating tarsal tunnel syndrome, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with tarsal tunnel syndrome and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
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References

1. Keck C, et al. “The tarsal-tunnel syndrome.” J Bone Joint Surg Am. 1962;44(1):180-182. JBJS
2. Pfeiffer WH, et al. “Tarsal tunnel syndrome: diagnosis and treatment.” Foot Ankle Int. 1993;14(2):88-92. SAGE Journals
3. Dellon AL. “Treatment of tarsal tunnel syndrome by decompression of the tibial nerve.” Plast Reconstr Surg. 1992;89(4):689-697. Plastic and Reconstructive Surgery
4. Hauser RA, et al. “A systematic review of prolotherapy for chronic musculoskeletal pain.” Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139-159. SAGE Journals
5. Rabago D, et al. “Prolotherapy in primary care practice.” Prim Care. 2010;37(1):65-80. PMC