Tarsal Tunnel Syndrome

As it travels from the leg to the foot, the posterior tibial nerve, which supplies feeling and movement to parts of the foot, must pass through a small opening of bone and ligament on the inside of the ankle called the tarsal tunnel. If the nerve gets compressed in this region, tarsal tunnel syndrome can develop. This painful condition may lead to loss of feeling or movement in the foot.

People born with flat fleet are more likely to develop symptoms of tarsal tunnel syndrome due to the inward pressure applied to the ankle area when walking. Tarsal tunnel syndrome also can be caused by coexisting medical conditions that lead to swelling in the legs and feet or by occupations that require long hours walking or standing.

Most people with tarsal tunnel syndrome report some type of ankle pain as the primary symptom, though many other conditions can cause pain in the ankle and foot. If you experience any type of lingering discomfort in your feet, whether it is pain that comes on suddenly or tingling that develops over time, you should see an orthopedic doctor or foot specialist for an evaluation. An accurate diagnosis can lead to early intervention and possibly allow you to avoid surgery.

The most common signs and symptoms of tarsal tunnel syndrome include:

• Loss of sensation on the sole of the foot

• Tingling or burning sensations in the calf, ankle or foot

• Pain in the ankle or foot. People with tarsal tunnel syndrome pain often characterize it as shooting pain through the sole of the foot.

Tarsal tunnel syndrome symptoms mimic those of other nerve injuries and disorders. Ankle and foot conditions that can cause similar symptoms include arthritis, plantar fasciitis, and diabetic neuropathy. See an experienced orthopedic surgeon, podiatrist, or sports medicine doctor to diagnose your foot problem and start you down a path to prompt treatment.

Nerve compression causes tarsal tunnel syndrome. The syndrome can develop when the posterior tibial nerve becomes compressed for any reason where it passes through the tarsal tunnel.

Many factors can cause posterior tibial nerve compression inside the tarsal tunnel including: 

• Arthritis or bone spurs in the ankle that rub against the nerve where it passes through the tarsal tunnel

• Edema (swelling) in the ankle due to a medical condition like heart failure or diabetes

• Localized medical conditions, such as cysts or varicose veins in the ankle that can press against the nerve and cause inflammation (neuritis)

• Direct injury to the ankle

Certain lifestyle choices and medical conditions may increase your risk of developing tarsal tunnel syndrome including:

• Foot structural abnormalities like fallen arches (flat feet), which can be congenital (present at birth) or acquired (developing throughout one’s lifetime)

• Arthritis in the ankle

• Medical conditions like diabetes, heart failure, and arthritis that cause swelling (edema) in the lower extremities

• Occupations that require long periods of walking or standing, which puts pressure on the structures within the ankles

• Overweight or obesity, which unduly stresses the ankle joint

• Personal history of ankle injuries

You may be able to reduce your risk by:

• Avoiding, or taking frequent breaks from activities that keep you on your feet for long periods of time

• Correcting foot structural abnormalities as directed by a doctor, such as by using shoe inserts

• Maintaining a healthy weight

• Treating medical conditions that can lead to ankle swelling

If you experience symptoms of tarsal tunnel syndrome, you should consult a doctor to receive an accurate diagnosis and to rule out more serious conditions like diabetes that could be causing your foot pain.

The goal of tarsal tunnel syndrome treatment is to relieve nerve compression. Surgery has the potential for complications, so most doctors will exhaust all nonsurgical treatment options before suggesting surgery to decompress the nerve. Elements of the RICE method (rest, ice, compression and elevation), a common treatment for orthopedic injuries, can be effective for tarsal tunnel syndrome.

Treatment for tarsal tunnel syndrome may include:

• Anti-inflammatory drugs including oral medications and corticosteroid injections

• Bracing or immobilizing the ankle

• Cold therapy or ice packs to reduce inflammation

• Physical therapy to strengthen muscles in the ankle and improve gait

• Resting the ankle and foot

• Shoe inserts or switching to highly supportive shoes

• Surgery to decompress (release) the posterior tibial nerve

• Treatment of any underlying medical conditions causing the legs and feet to swell

If the posterior tibial nerve remains compressed and inflamed over a long period of time, nerve damage can become permanent. You might experience some loss of motor function in your feet, which can increase your risk of stumbling or falling. Chronic pain from untreated tarsal tunnel syndrome can also result in a poor quality of life.

Fortunately, many cases of tarsal tunnel syndrome respond well to conservative treatments when started early.