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Tarsal Tunnel Syndrome

Understanding Tarsal Tunnel Syndrome: Causes, Symptoms, and Relief Strategies

Struggling with foot pain, numbness, or a tingling sensation could point to tarsal tunnel syndrome, a nerve compression issue often overlooked. This condition affects the posterior tibial nerve within the ankle’s tarsal tunnel. Our comprehensive guide explores the roots of tarsal tunnel syndrome, its symptoms, and the best practices for conservative and surgical management, aiming to provide practical pathways to relief.

Key Takeaways

  • Tarsal Tunnel Syndrome (TTS) is a rare nerve compression disorder affecting the tibial nerve within the tarsal tunnel, with symptoms including pain, burning, numbness, and tingling in the feet and toes.
  • Causes of TTS range from intrinsic factors like tendinopathy and fibrosis to extrinsic factors such as ill-fitting shoes and trauma, and risk factors include obesity and rheumatoid arthritis.
  • Treatment options for TTS vary from conservative approaches like physical therapy and orthotics to surgical interventions such as tarsal tunnel release, with patient education and preventative measures necessary for managing the condition.

Understanding Tarsal Tunnel Syndrome

Illustration of posterior tibial nerve

Posterior tarsal tunnel syndrome, also known as posterior tibial nerve neuralgia or posterior tibial neuralgia, is caused by compression of the posterior tibial nerve within the narrow space called the tarsal tunnel. This can occur when structures such as tendons and muscles surrounding this nerve become inflamed and swollen in this confined area created by bone and connective tissue. While no definite statistics exist on its prevalence and incidence rates, it is considered uncommon.

This disorder presents with various symptoms ranging from mild discomfort to intense pain. Patients typically experience burning sensations, numbness, and tingling at the bottom of their feet or toes due to pressure on two vital nerves – lateral plantar nerves (one being lateral) that branch off from it within this tight space along with other structures like flexor hallucis longus muscle/tendon & digitorum tendon.

Causes and Risk Factors

Tarsal tunnel syndrome can result from a combination of internal and external factors. These may include issues such as tendinopathy, fibrosis, osteophytes, enlargement or thickening of the flexor retinaculum and wearing ill-fitting shoes. Trauma to the foot can also contribute to the development of this condition.

To better understand these underlying causes and potential risk factors for tarsal tunnel syndrome, we will Explore each individually in subsequent sections. It is essential not to overlook any factors that may lead to this painful nerve disorder within the tarsal tunnel area.

Intrinsic Causes

Tarsal tunnel syndrome (TTS) can be caused by conditions originating within the foot and ankle. One of these causes is tendinopathy, which involves the deterioration of a tendon due to overuse or age. This issue can lead to compression in the tarsal tunnel, resulting in TTS symptoms. Another internal cause is fibrosis, thickened or scarred connective tissue that may compress the tibial nerve.

Aside from swollen tendons and fibrosis, other intrinsic abnormalities contribute to TTS development. These include tenosynovitis (the swelling of a sheath surrounding a tendon), perineural fibrosis (thickening of nerve tissue), and osteophytes (bone spurs). Even anatomical differences like flat feet or hindfoot valgus deformity have been linked with an increased risk of developing TTS.

Extrinsic Causes

Extrinsic factors originating outside of the foot and ankle can also cause TTS. A common external cause is wearing ill-fitting shoes that are too tight or do not provide proper foot support. This can result in excessive motion, deformation of the foot structure, abnormal pressure on the tarsal tunnel area, and potentially damage to nerves such as the posterior tibial nerve.

Physical trauma to the foot or ankle is another major extrinsic factor linked with TTS development. The force from an injury can harm the posterior tibial nerve within its designated pathway through the narrow space known as a “tarsal tunnel,” leading to symptoms associated with TTS. However, repetitive strenuous activities like sprinting and jumping may also contribute towards developing this condition due to the constant stress placed upon these areas.

Risk Factors

Aside from underlying and external causes, various risk factors can heighten the chances of developing Tarsal Tunnel Syndrome (TTS). These include being overweight, having rheumatoid arthritis, and even a genetic predisposition.

For instance, obesity places added pressure on the tibial nerve through compression in the tarsal tunnel area. This can ultimately result in TTS. To this mechanical factor, chronic synovitis, often found in individuals with rheumatoid arthritis, has also been linked to an increased risk of developing TTS.

Symptoms and Presentation

Photo of symptomatic foot

In this section, we will delve into the signs of TTS after discussing its causes and potential risk factors. The main indications include discomfort, burning sensation, tingling or numbness in the foot and toes. Sometimes, these symptoms may also extend to other areas like legs or soles.

An intriguing aspect of TTS is that physical activities can influence symptom severity. Engaging in prolonged standing, walking or running can aggravate pain due to increased pressure on the tarsal tunnel and posterior tibial nerve.

It’s worth noting that even though discussed earlier as a cause for TTS development, different risk factors could play a role here by affecting how severe one’s complaints are. Those associated with higher incidence rates were injury, some medical conditions, pregnancy, having flat feet- obese persons- participating in certain athletic sports. Secondly, it is not surprising.

Living an active lifestyle stood out across all patient groups examined, including being augmented when wearing unsupportive footwear. Finally, the protective roles varying in age (older) and gender seem less understood now. In summary, it is just essential not to ignore such issues, especially since addressing better management methods should be coupled with more research funding to find new treatment modalities, as early intervention increases the prognosis for successful outcomes while achieving better outcomes.

Diagnostic Approaches

Illustration of nerve conduction studies

Detecting TTS can be difficult due to its intricate nature and similarities with other conditions. A comprehensive medical history and thorough physical examination are the initial steps towards identifying tarsal tunnel syndrome.

Additional diagnostic procedures for diagnosing this condition may include:

  • Imaging tests like an MRI provide detailed images of the tarsal tunnel and paths taken by branches of the posterior tibial nerve.
  • Nerve conduction studies that offer insights into nerve functionality.
  • Electromyography provides information on muscle function.

Differential Diagnosis

TTS is a complex condition, making it common for misdiagnosis as other conditions with similar symptoms. This is where the technique of differential diagnosis comes into play. To accurately diagnose TTS, healthcare providers must consider and rule out other potential causes, such as plantar fasciitis, stress fractures, Achilles tendonitis and compartment syndrome of the deep flexor compartment.

To differentiate TTS from these similar conditions during the diagnostic process, healthcare professionals may utilise various tests. For example, electrodiagnostic testing can help distinguish between polyneuropathy and TTS, while thorough examination techniques aid in differentiating nerve root syndromes from TSS.

Conservative Treatment Options

Conservative treatment is often the initial approach in managing TTS. This can involve various options such as physical therapy, orthotics, shoe modifications, medications and lifestyle changes.

Physical therapy may be recommended to address any underlying muscle imbalances or weaknesses that could contribute to TTS. Orthotic devices like arch supports or heel cups may also be prescribed to improve foot mechanics and reduce strain on the affected area.

Modifying shoes with added padding or supportive features can alleviate pressure on the tibial nerve. Medications for pain management may also be used if necessary.

Physical Therapy

Illustration of nerve mobilization exercise

Physical therapy is essential to treating Tarsal Tunnel Syndrome (TTS). It consists of various personalised exercises and stretches to address the individual’s symptoms and condition. These activities may include calf stretching techniques and nerve gliding movements, which can relieve irritation, minimise symptoms, and improve overall functioning.

Physical therapy sessions for TTS often incorporate ice packs and soft tissue massage for targeted exercises. These interventions help manage inflammation in the affected area while also promoting healing. Typically lasting around six weeks with two or three sessions per week, physical therapy plays a critical role in effectively managing Tarsal Tunnel Syndrome through various approaches, including exercise routines that aid in reducing discomfort and utilising methods such as icing sore areas to facilitate recovery.

Orthotics and Shoe Modifications

Orthotics and shoe modifications can be highly beneficial in managing Tarsal Tunnel Syndrome (TTS) symptoms. Research has shown that orthotics designed to reduce the inward rotation of the heel, prevent collapse of the medial arch, and provide slight ankle support have proven effective for alleviating TTS. Modifying footwear with features such as good arch support, cushioning, a sturdy heel counter, and extra depth for added space within the shoe’s interior area may also help alleviate the pain associated with TTS.

Choosing appropriate footwear is crucial when effectively managing Tarsal Tunnel Syndrome (TTS) symptoms. By selecting stable shoes that offer strong arch supports, you can significantly decrease any tendency towards pronation or rolling-inward movements by your heels while walking. Furthermore, opting for high-quality cushioned materials, wearing thick-soled supportive inserts, and choosing ample room between toes are all beneficial ways to avoid discomfort. Remember, it only takes a few well-considered changes to manage this condition successfully, like the one we mentioned.

If you struggle with pesky cases of tingly, burning skin, you might have a problem.

Medications and Lifestyle Changes

To alleviate the pain associated with TTS, doctors may recommend using nonsteroidal anti-inflammatory drugs (NSAIDs) and oral analgesics. Alongside medication, certain lifestyle adjustments can also help manage symptoms of this condition. This may involve modifying daily activities to reduce pressure on the foot, taking regular breaks throughout the day, and incorporating stretching exercises into one’s routine. In some cases, neuropathic pain medications like gabapentin may also be prescribed as part of a treatment plan for TTS.

Surgical Interventions

Illustration of surgical intervention

In cases where traditional treatments are not effective, or TTS symptoms are severe, surgical options may be necessary to address tarsal tunnel syndrome. The most commonly performed surgery for this condition is known as a tarsal tunnel release, which involves an incision along the inner ankle and bottom of the foot to relieve pressure on the tibial nerve.

The success rate for surgeries aimed at treating TTS can vary but typically has about an 80% chance of achieving positive results through decompression. Like any surgery, potential risks include developing scarring that causes pain or discomfort, wound infections and lasting paresthesia (changes in sensation) within the affected foot after surgery.

Postoperative Care and Rehabilitation

Proper postoperative care and rehabilitation after TTS surgery are essential for a successful recovery. It involves protecting the joint and nerve, managing inflammation, preventing scar tissue formation, and returning to standard walking patterns.

To ensure the integrity of the treated area remains intact during healing, patients will need to be cautious in their movements. This can include avoiding strenuous activities or using a protective splint when necessary. Inflammation must also be carefully managed through medication or other treatments recommended by healthcare professionals.

One key aspect of rehabilitation is addressing scar tissue adhesion prevention techniques. If improperly managed, scar tissue can develop around surgical sites, impeding movement and hindering full recovery potential. Gait training may also be included in rehab efforts so that patients can gradually regain their pre-surgical gait mechanics.

Prevention and Patient Education

Preventing TTS is not a guaranteed outcome, but implementing specific measures can decrease its likelihood. These include taking breaks to rest the feet, applying ice to alleviate inflammation, properly fitting shoes for support and engaging in physical therapy that targets muscle imbalances.

Patient education also plays a vital role in managing TTS effectively. It involves awareness of the symptoms associated with this condition, recognising the significance of seeking medical attention promptly and adopting a healthy lifestyle to reduce risk factors. Additionally, supportive actions such as participating in regular physical activity will prove beneficial towards reducing inflammation within affected areas.


As we’ve seen, TTS is a complex condition with many causes, symptoms, and treatment options. From intrinsic and extrinsic causes to a range of conservative and surgical treatments, understanding TTS is no small feat. However, managing TTS is entirely possible with the proper knowledge and medical assistance. Remember, early diagnosis and management are crucial to preventing long-term complications. So, listen to your body and take action when necessary.

Frequently Asked Questions

How do you fix tarsal tunnel syndrome?

To address tarsal tunnel syndrome, there are nonsurgical methods available, such as administering anti-inflammatory medications and steroid injections. Another approach is to use orthotic devices that help alleviate pressure on the foot and nerve. These treatments can effectively target this condition without resorting to surgery.

Does the tarsal tunnel ever go away?

Treating the root cause, such as a bone spur or lipoma, can sometimes relieve tarsal tunnel syndrome symptoms. Many individuals continue to deal with these symptoms over an extended period.

What are the symptoms of tarsal tunnel syndrome?

Tarsal tunnel syndrome, also known as posterior tibial neuralgia, is characterised by shooting pain, numbness, tingling and a burning sensation in the foot. This condition is more commonly seen in people with chronic swelling of their feet due to conditions like arthritis or diabetes.

It can manifest itself through discomfort along the path of a nerve that runs from inside your ankle towards your toes – this pathway is referred to as a ‘tunnel’. Symptoms may vary from person to person but often include painful sensations and sensory changes felt throughout one’s foot. TTS could be aggravated when taking part in activities.

What can be mistaken for tarsal tunnel syndrome?

Correctly identifying nerve involvement is essential in diagnosing and treating tarsal tunnel syndrome, as it can often be confused with other conditions like plantar fasciitis. Failure to accurately diagnose the condition may result in inappropriate treatment.

Misinterpreting tarsal tunnel syndrome for another condition can lead to ineffective or harmful treatments. A thorough evaluation of symptoms is crucial in distinguishing between situations and determining the best course of action for proper treatment.

What is tarsal tunnel syndrome?

Tarsal tunnel syndrome, or posterior tibial nerve neuralgia, is caused by posterior tibial nerve compression within the tarsal tunnel area. This disorder affects specifically the posterior tibial nerve and can result in pain and discomfort due to its compressed state. It is classified as a type of nerve.

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