Tarsal Tunnel Syndrome

What is the tarsal tunnel?

The tarsal tunnel is an area located on the inside of the ankle, between the bony part of the ankle (called the medial malleolus) and the Achilles tendon.

Why is the tarsal tunnel important?

The tarsal tunnel houses many important anatomical structures. These include the posterior tibial artery, the posterior tibialis tendon (an important and commonly injured tendon) and the posterior tibial nerve – which is the main structure associated with tarsal tunnel syndrome.

What is tarsal tunnel syndrome?

In simple terms tarsal tunnel syndrome (TTS) is any compression or irritation causing injury to the posterior tibial nerve. This injury or irritation may be in the form of nerve compression, entrapment or impingement which may also be commonly described as a ‘pinched nerve’.

Symptoms can present directly at the location of the injury but can also be referred to any area along which the nerve pathway runs; such as the big toe, arch and heel of the foot.

Tarsal tunnel syndrome is similar to the well-known carpal tunnel syndrome, in that both are related to compression or irritation to a nerve in a small, narrowed space.

Causes of tarsal tunnel syndrome

Tarsal tunnel syndrome may be caused by anything which results in, or causes direct or indirect compression of the posterior tibial nerve.

Common causes of TTS include:

• Flat feet – excessive “rolling in” or pronation of the heels and/or arches of the foot can result in excess compression and pressure on the nerve.
• An injury to another structure in the tarsal tunnel (e.g. posterior tibial tendon) that results in local inflammation and thickening of the tendon – which can put more pressure on the nerve.
• An acute or past severe injury to the foot/ankle – such as a high level ankle sprain that results in large amounts of swelling surrounding the ankle near the tarsal tunnel. An example is the process of severe ankle swelling as the result of an ankle ligament tear.

Less common causes of TTS include:

• Irregular or enlarged structures arising in the area, such as ganglion cysts, accessory bones/bone spurs and varicose veins.
• In addition, systemic diseases such as various types of arthritis and diabetes can also play a role.

Symptoms of tarsal tunnel syndrome

The intensity of tarsal tunnel syndrome, as well as the symptoms can vary. The pain may be a mild to moderate discomfort – which may not interrupt day to day activities, but may make exercise or more intense activity difficult. Others find that it can be debilitating to the point whereby any prolonged walking or standing on the feet is not possible or results in severe pain.

Common symptoms of TTS include:

• Pain (at the tarsal tunnel or referred pain along the course of the nerve)
• Tingling/burning – often felt along in the inside of the arch ranging from the big toe all the way to heel or under the sole of the foot
• Numbness or altered sensation of the foot or ankle

Treatment options for tarsal tunnel syndrome

Thankfully there are many podiatry treatment options available for tarsal tunnel syndrome that often result in successful treatment. However, these will depend on many factors such as severity of injury, foot type, shoes and activity. Some people may require multiple treatment interventions for a complete resolution of symptoms.

Common treatment options for TTS include:

• Orthotics
• Stretching and strengthening programs
• Footwear modification
• Rest/Ice
• Oral medications (such as NSAIDs)
• Heat ultrasound
• Heel lift inserts

Less common treatment options for TTS include:

• Immobilisation or CAM walker
• Injection therapy
• In chronic severe cases, surgical intervention may be required.

If you suffer from tarsal tunnel syndrome see a podiatrist

If you suffer from any pain resulting in a burning, tingling or sharp feeling in your arches or ankle, you may be suffering from a case of tarsal tunnel syndrome.

Make an appointment today with one of our Melbourne Podiatrists to have your foot and ankle comprehensively assessed, properly diagnosed and have an effective treatment plan developed to solve your pain!