Tarsal tunnel syndrome

If you’re experiencing pain, numbness and tingling in your ankle or foot, it could be caused by tarsal tunnel syndrome (TTS). This condition happens when the tibial nerve that runs along your ankle becomes compressed or pinched due to an injury, overuse or a disease that harms the peripheral nerves in your feet, like diabetes.

TTS can keep you from the activities you enjoy most. Our orthopedic specialists will work with you to customize a care plan that may include surgical or nonsurgical options to treat your tibial nerve damage.

What is tarsal tunnel syndrome?

Tarsal tunnel syndrome is also known as tibial nerve dysfunction. Your tibial nerve helps carry sensory and motor function messages from your brain to 21 different muscles in the lower part of your leg.

Your tibial nerve starts at your knee and runs through your tarsal tunnel – a narrow passage of bones and ligaments in your ankle. When part of your tibial nerve is damaged or compressed, TTS happens. Symptoms may include inner ankle pain, a sharp pain in your foot or even tingling in your foot.

What causes tarsal tunnel syndrome?

Tarsal tunnel syndrome can happen to anyone. Several factors can damage your tibial nerve, including:

• Bone spurs
• Diabetic neuropathy, a complication of diabetes
• Having flat feet or high arches
• Inflammation from a disease like arthritis
• Overuse injury
• Swelling from an ankle sprain or fracture
• Tumors near your tibial nerve
• Varicose veins

Tarsal tunnel syndrome symptoms

If you have tarsal tunnel syndrome, you’ll likely experience some form of nerve pain in the affected foot and ankle. Symptoms may get worse after physical activity and will range in severity.

Common symptoms of TTS include:

• A burning sensation, often on the bottom of your foot
• Numbness or tingling in your foot
• Pain in your inner ankle, foot or toes
• Weakness in your foot

Symptoms of TTS may increase and worsen over time. That's why it’s important to seek treatment before the nerve damage worsens and symptoms are harder to manage.

Diagnosing tarsal tunnel syndrome

Your doctor will first review your symptoms, health history and perform a physical examination of your foot. There’s no tarsal tunnel syndrome test, but imaging tests and other simple tests can help diagnose TTS.

TTS testing may include:

• Tinel’s test: Your doctor will tap on the skin above the tibial nerve to indicate where you feel the tingling sensation (known as Tinel’s sign).
• MRI: This test uses a powerful magnet, radiofrequencies and computer technology to create detailed images of your soft tissue and bones that look for injury or nerve damage.
• Electromyography (EMG): An EMG measures nerve and muscle function.

How do you fix tarsal tunnel syndrome?

Tarsal tunnel syndrome can be managed or cured with a variety of noninvasive and minimally invasive treatments. Your treatment plan will depend on the cause of your nerve compression, your personal health history and the extent of your nerve damage.

Nonsurgical tarsal tunnel syndrome treatment

For some, a cast or splint will be recommended to take pressure off your foot, allowing your nerve to heal. Steroid injections are also an option for intense inflammation and pain.

There’s also a variety of effective ways to manage symptoms of TTS at home. Your doctor may recommend you try:

• Using an over-the-counter anti-inflammatory medicine like ibuprofen to control pain
• Icing your foot for 10 to 20 minutes to reduce swelling and pain
• Resting and elevating your foot to help heal an injury and reduce swelling
• Wrapping your foot in a compression bandage or brace
• Decreasing your physical activity or switching to low-impact activities
• Using arch supports, heel cushions or custom foot orthotics (inserts) in your shoes if you have flat feet or high arches

Orthopedic rehab is also an important part of TTS recovery for many. Physical therapy activities can improve your strength and help you get back to your pre-TTS range of motion.

Surgical tarsal tunnel syndrome treatment

If you have a severe or long-term case of tarsal tunnel syndrome and have exhausted nonsurgical options, your doctor may recommend tarsal tunnel surgery. The goal of surgery is to relieve the pressure on the tibial nerve.

One surgical option is a tarsal tunnel release, where the ligament inside your tarsal tunnel is released, removing the pressure from your tibial nerve.

If your TTS is caused by a tumor or bone growth, surgery may be recommended to treat your underlying condition.

Does tarsal tunnel ever go away?

With diagnosis and treatment, tarsal tunnel syndrome can be cured. The faster you seek treatment, the better your outlook will be as you’ll minimize the risk of severe nerve damage. It’s also important to follow through with any at-home exercises and treatments your doctor or physical therapist recommends to you.