Tarsal Tunnel Syndrome

Tarsal tunnel syndrome, occurring in the foot, is similar to carpal tunnel syndrome, which occurs in the wrist.  It is the result of pressure on the tibial nerve as it runs through the inside of the foot and ankle.  Intense pain often accompanies this nerve compression limiting activities leading to the need for treatment by a foot and ankle specialist.

Traumatic injury, such as an ankle sprain or other injury to the ankle, usually causes tarsal tunnel syndrome, though other causes can include:

• Pronation – Rolling your feet inward when walking or running, which can later cause flat feet.
• Swelling of the flexor tendons – These tendons, which run down the inside of the ankle and under the foot to the toes, allow you to move your toes.
• Inflammatory arthritis – Inflamed joints cause pressure and swelling, and thus can negatively affect the tibial nerve.
• Venous stasis edema/swelling – This malfunction of the venous circulatory system causes blood to back up and pool in the tissue, thus inflicting pressure on the tibial nerve.

Those with tarsal tunnel syndrome will experience foot pain, usually a burning or tingling (pins and needles) sensation around the ankle. You may also feel some numbness on the bottom of the foot; however, the number one symptom is pain that radiates distally to the toes.

Also watch for:

• Pain that radiates proximally to the thigh and buttocks.
• Pain that worsens with standing and walking, yet eases
  when resting.
• Increased pain when wearing shoes.
• More intense pain at night.

Initial relief may be found with massage, foot and ankle range of motion exercises and leg elevation. Range of motion exercises involve pulling the foot up and pointing it down, as well as making small inward and outward circles with your foot.

Treatment should include support to the foot and ankle, either in the form of a removal device or applied strapping. Casting may be beneficial.

• Other treatment options include:
• Applying ice to reduce inflammation.
• Stabilizing the foot with orthotics or arch supports to prevent pronation, which stretches the posterior tibial nerve.
• Wearing shoes that can help correct pronation/ over-pronation, such as Aetrex 854 athletic walking shoes for men and women.
• Taking oral anti-inflammatory medications such as ibuprofen (or prescription NSAID drugs).
• With the supervision of a doctor: Injecting steroids and an anesthetic agent.

Surgical nerve decompression by a board certified podiatrist is often necessary to alleviate long-term pain. This surgical procedure relieves the scar tissue that has inevitably built up around the nerve causing
the pain.

This information on foot, leg and lower body health conditions is provided by The Podiatry Institute, dedicated to advancing the standard of care in podiatric medicine and its effects on musculoskeletal health. The Podiatry Institute does not endorse a specific treatment, product, or therapy. This information is not intended to be a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider on all matters relating to this or any other condition that may affect your health.