Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is compression or squeezing on the posterior tibial nerve at the inner aspect of the ankle. This painful condition is often due to injury or inflammation. Similar to carpal tunnel syndrome, tarsal tunnel refers to the compression of a nerve in a confined space.

The tarsal tunnel is an area created by the very strong, laciniate ligament that covers a bony canal through which pass some of the major nerve, artery, vein, and tendons of the foot. Individuals who suffer from tarsal tunnel syndrome exhibit symptoms that include tingling, burning sensations, numbness, and shooting pain.

These symptoms occur most often at rest or just before sleeping at night.

Cause

Tarsal tunnel syndrome may be caused by:

  • An injury such as a fracture, ankle sprain, or contusion
  • Arthritis
  • Diabetes
  • Masses pressing on the nerve
  • Strenuous athletic activity
  • Varicose veins that press on the nerve
  • Abnormally large nerves which result in the compression against the ligament that covers the tarsal tunnel
  • Continuous, multiple traumas that stretch the nerve
  • Compensating for other leg or foot problems such as short leg syndrome, hip and knee abnormalities, or heel pain

Symptoms

Symptoms of tarsal tunnel syndrome (TTS) may include:

  • Shooting pain in the foot
  • Numbness
  • Tingling or burning sensation

Diagnosis

Proper diagnosis of a tarsal tunnel syndrome requires the expert attention of experienced orthopaedic specialists.

Diagnosis will include:

  • A comprehensive clinical exam
  • Complete medical history
  • Electrical testing (EMG or nerve conduction study)
  • Imaging (X-rays, CT, or MRI scans)

Diagnosis is necessary to determine the severity of the condition, so the appropriate treatment plan, including a surgical option, can be considered.

Treatment

Whenever possible, Wisconsin Bone & Joint orthopaedic surgeons will prescribe nonsurgical treatment options before surgery is recommended.

Possible treatment options may include anti-inflammatory medications or steroid injections into the nerves in the tarsal tunnel to relieve pressure and swelling.

Orthosis (e.g., braces, splints, orthotic devices) may be recommended to reduce pressure on the foot and limit movement that could cause compression on the nerve.

Surgery for Tarsal Tunnel Syndrome

Depending on the severity of the condition, one of several surgical options may be recommended, including:

Tarsal Tunnel Release

The procedure to release the flexor retinaculum can usually be done using either a spinal type anesthetic or a general anesthetic. Once you have anesthesia, your surgeon will make sure the skin of your leg and ankle are free of infection by cleaning the skin with a germ-killing solution.

The surgeon then makes a small incision in the skin behind the inside ankle bone (medial malleolus). The incision is made along the course of the tibial nerve where it curves behind the malleolus. The nerve is located and released by cutting the flexor retinaculum. The surgeon will then surgically follow the nerve into the foot, making sure the nerve is free of pressure throughout its course.

The flexor retinaculum is left open to give the nerves more space. Eventually, the gap between the two ends of the flexor retinaculum fills in with scar tissue.   Following surgery, the skin is repaired with stitches.

Your Doctors

Tips for Healthy Feet

  • Don’t ignore foot pain, it isn’t normal. If pain persists, see a physician.
  • Inspect your feet regularly. Note changes in color and temperature, thickness or discoloration of nails, and cracks or cuts in the skin. Peeling or scaling on the soles could indicate athlete’s foot. Any growth on the foot is not considered normal.
  • Wash your feet regularly, especially between the toes. Be sure to dry them completely.
  • Trim toenails straight across, but not too short. Be careful not to cut nails in corners or on the sides; it can lead to ingrown toenails. People with diabetes, poor circulation, or heart problems are more prone to infection and should not treat their own feet.
  • Make sure that your shoes fit properly. Replace worn-out shoes as soon as possible, and try on new shoes later in the day when feet tend to be at their largest.
  • Select and wear the right shoe for your activity, in other words, running shoes for running.
  • Don’t wear the same pair of shoes every day, but rather alternate them.
  • Avoid walking barefoot. Your feet are more prone to injury and infection when walking barefoot. When at the beach or wearing sandals, remember to use sunscreen on your feet as well as the rest of your body.
  • Use home remedies cautiously. Self-treatment often turns a minor injury into a major foot problem. If you have diabetes, it is essential that you see a podiatric physician at least once a year for a thorough check-up.