Ease the Squeeze: Strategies for Managing Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome (TTS) is a medical condition that involves compression or irritation of the tibial nerve as it passes through the tarsal tunnel, a narrow space on the inside of the ankle that is similar to carpal tunnel syndrome in the wrist. The tibial nerve provides sensation and motor function to the bottom of the foot. When it becomes compressed or irritated, it can lead to various symptoms.

What are the symptoms of tarsal tunnel syndrome?

Common symptoms of tarsal tunnel syndrome include:

  • Pain: This can be sharp, shooting, burning, or tingling pain in the inside of the ankle, heel, and sole of the foot.
  • Numbness and Tingling: Patients may experience numbness or tingling sensations in the sole of the foot or toes.
  • Weakness: Weakness in the muscles supplied by the tibial nerve may be experienced, leading to difficulties with walking or standing.
  • Radiating Pain: The pain may radiate along the path of the tibial nerve, traveling up the leg.

Often, symptoms worsen during or after physical activity, but if TTS is severe or long-lasting, you may experience symptoms all the time.

What are the most likely causes of tarsal tunnel syndrome?

tarsal tunnel syndrome infographic

TTS may be caused by any condition that strains or compresses the tibial nerve, including:

  • Severely flat feet that can stretch the tibial nerve
  • Fallen arches or high arches
  • Injuries or trauma that cause swelling such as an injury to the ankle, sprain or fracture
  • Body-wide systemic conditions such as hypothyroidism, arthritis or diabetes, which can cause swelling and nerve compression
  • Irregular growths such as a ganglion cyst, a swollen tendon or bone spur
  • Varicose veins in the membrane surrounding the tibial nerve, which cause compression on the nerve
  • Lesions and masses such as lipomas or tumors near the tibial nerve
  • An overuse injury

How is tarsal tunnel syndrome diagnosed?

Diagnosing TTS requires the expert attention of experienced neurologists and nerve specialists. It is important that the doctor determine the severity of the condition in order to recommend the most appropriate treatment plan, including surgery if necessary.

A diagnostic workup for TTS may involve a combination of: a complete medical history, a comprehensive physical examination to assess the patients symptoms, check for specific points of tenderness, evaluate the foot’s sensation and muscle strength, as well as electrical testing (EMG or a nerve conduction study) and/or imaging studies such as X-rays, a CT scan or MRI, to visualize the structures in the tarsal tunnel and rule out other possible causes of the symptoms.

What treatments are available for tarsal tunnel syndrome?

Treatment options for tarsal tunnel syndrome depend on the severity of the condition. Mild cases can often be managed with conservative measures:

  • Rest and reducing activities that worsen symptoms
  • Ice to reduce inflammation
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and inflammation
  • Custom-made shoe inserts to help your foot maintain a proper arch. This position reduces the movements that cause nerve compression. A stability or motion-controlled shoe also keeps your foot from rolling inward (pronation) and reduces tension on your nerve.
  • Orthotic devices, such as braces, casts, or splints to help reduce pressure on the foot and limit movement that could cause compression on the nerve.
  • Shoe modifications to alleviate pressure on the nerve
  • Physical therapy to improve flexibility and strengthen surrounding muscles, including prescribed exercises and stretches
  • Corticosteroid Injections: Injections of corticosteroids around the tarsal tunnel can help reduce inflammation and relieve symptoms

When is tarsal tunnel surgery necessary?

If conservative treatments don't provide relief, ultimately, surgery might be considered to release the pressure on the tibial nerve called tarsal tunnel release. This involves cutting the ligament that forms the roof of the tarsal tunnel and creating more space for the nerve. In tarsal tunnel release, the surgeon creates an opening behind the ankle that extends down to the arch of the foot. The surgeon carefully divides the ligament, so it is not pressing against the tibial nerve. Or the surgeon may need to widen the tarsal tunnel. If a mass is putting pressure on your nerve, your surgeon will remove it.

How long is recovery for tarsal tunnel surgery

Tarsal tunnel release is an outpatient surgery, so the patient can leave the same day. Recovery first starts with minimizing pain and caring for the incision. The minimally invasive surgery reduces the recovery time significantly, allowing for light walking after one week. After that, the patient will need physical therapy to return to normal activities like running.

The patient should perform prescribed exercises both at home and with a physical therapist. Doctors usually recommend patients move only short distances while closely monitoring pain. Full, pain-free recovery takes about 6-12 months.

Can tarsal tunnel syndrome be prevented?

There’s no sure way to prevent tarsal tunnel syndrome, but you can lower your risk of developing TTS if you adhere to the following:

  • Rest between workouts to avoid overuse injuries.
  • Stretch your feet and ankles regularly.
  • Warm up before exercise.
  • Wear proper-fitting, supportive footwear.

Symptoms of TTS may go away after you treat the underlying cause of TTS. For example, if you have a bone spur or lipoma, symptoms may disappear after treatment. However, TTS is less likely to go away entirely if you have a chronic condition such as arthritis. Without treatment, TTS can lead to nerve damage, which can be permanent and irreversible, causing difficulty walking, exercising or performing your daily activities.

The outcome of tarsal tunnel syndrome treatment varies depending on factors such as the severity of the condition, the effectiveness of the chosen treatment approach, and the individual patient's response. Many individuals experience improvement in their symptoms with conservative measures or surgical intervention if necessary. However, it's important to note that nerve-related conditions can be complex; and complete resolution of symptoms is not guaranteed for everyone. Early diagnosis and appropriate treatment can significantly improve the chances of a positive outcome or may even cure the condition.

Early action is important!

Don’t ignore your feet. If you suspect you have tarsal tunnel syndrome or are experiencing symptoms, you should consult a medical professional for proper evaluation and guidance tailored to your specific situation. It’s important to get treatment as soon as you start experiencing symptoms.

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