Tarsal Tunnel Syndrome

The physicians at Premier Medical Group’s Podiatry Division specialize in treating individuals both medically and surgically for foot and ankle disorders. It is best not to ignore any possible tarsal tunnel syndrome (TTS) symptoms. Whether you suspect that something is wrong or you are not yet sure, Premier Medical Group can tell you what is going on and how to treat it.

What is the tarsal tunnel?

The tarsal tunnel is a narrow space that is located on the inside of the ankle and next to the ankle bones. It is the source of tarsal tunnel syndrome. The tunnel is covered with a thick ligament, which protects and maintains arteries, veins, tendons, and nerves.

One of the structures that it protects is the posterior tibial nerve. The nerve is directly affected by tarsal tunnel syndrome.

What is tarsal tunnel syndrome?

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Tarsal tunnel syndrome is when the posterior tibial nerve is compressed or squeezed. Pressure in the confined space leads to symptoms that can be anywhere along the path of the nerve. The nerve runs from the inside of the ankles into the foot. Tarsal tunnel syndrome has similarities to carpal tunnel syndrome in the wrist.

Who gets tarsal tunnel syndrome?

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Anyone can develop tarsal tunnel syndrome. The condition is caused by anything that results in compression on the nerve. Those at higher risk include a person with:

  • Flat feet, due to the outward tilting of the heel
  • High arches
  • An enlarged or abnormal structure that takes up space in the tunnel (ex. a varicose vein, ganglion cyst, swollen tendon, or arthritic bone spur)
  • An injury, such as an ankle sprain
  • A systemic disease (ex. diabetes or arthritis)

These conditions are not inherently linked to developing tarsal tunnel syndrome. Speak to your doctor if your circumstances are severe or you have any questions about your specific case.

What are the symptoms of tarsal tunnel syndrome?

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Before you are diagnosed with tarsal tunnel syndrome, you may experience symptoms such as:

  • Tingling
  • Burning
  • A sensation similar to an electrical shock
  • Numbness
  • Pain or shooting pain

Symptoms are not necessarily isolated to one area. You may feel discomfort or pain:

  • On the inside of the ankle
  • On the bottom of the foot
  • As far as the heel, arch, toes, or even the calf

Symptoms can occur seemingly out of nowhere for some people. Certain activities may trigger the symptoms, especially if you overuse your foot with:

  • Prolonged standing
  • Walking
  • Exercising

Do not delay seeking early treatment if you notice any possible signs of tarsal tunnel syndrome developing. Speak to a healthcare provider about next actions that make sense for you.

How do you test for tarsal tunnel syndrome?

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Set up an appointment with a healthcare provider to discuss potential tarsal tunnel syndrome symptoms. A doctor may examine the ankle or look for signs of any injuries. Other diagnostic testing can include:

  • Tinel’s test: A provider will gently tap the tibial nerve
  • Electromyogram (EMG): Measuring the nerve and muscle function
  • An MRI: Capturing a more detailed image (ex. Injuries, nerve damage, a mass)

What conditions are similar to tarsal tunnel syndrome?

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It is always advisable to reach out to a healthcare provider rather than self-diagnosing. Certain foot conditions have similar symptoms to that of tarsal tunnel syndrome. Conditions that might present similarly include:

  • Bursitis
  • Compartment syndrome
  • Plantar fasciitis
  • Tendinitis

What are the nonsurgical treatment options for tarsal tunnel syndrome?

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There are a number of non-surgical treatment options for addressing tarsal tunnel syndrome. A healthcare provider may instruct you to use one specific treatment method or a combination of methods to alleviate your discomfort. Common ones are:

  • Rest and/or elevation
  • Applying an ice pack to the affected area (20 minutes on, 40 minutes off)
  • Oral medications (ex. nonsteroidal anti-inflammatory drugs like ibuprofen)
  • Immobilization with a foot cast
  • Physical therapy or ultrasound therapy
  • Injection therapy (ex. a local anesthetic or corticosteroid)
  • Orthotic devices to help maintain the foot’s arch in a shoe
  • Supportive shoes
  • Bracing to reduce pressure

Speak to your doctor about finding the best solution for your specific condition. You may find that alternating less invasive treatment plans provide significant relief.

Does tarsal tunnel syndrome require surgery?

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Not necessarily, but surgery may be recommended. Tarsal tunnel syndrome symptoms that remain severe after exploring nonsurgical treatments may result in your healthcare provider talking to you about surgical procedures. Operations may include:

  • Releasing the tibial nerve
  • Widening the tarsal tunnel
  • Removing an existing mass that puts pressure on the nerve

Surgery is different for everyone. A foot and ankle surgeon will select the appropriate procedure based on the underlying cause of your condition.

How can you prevent tarsal tunnel syndrome?

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There is unfortunately no fully guaranteed method of preventing tarsal tunnel syndrome. Good ways to reduce the risk of developing tarsal tunnel syndrome are:

  • Resting between potentially strenuous workouts
  • Stretching your feet and ankles on a regular basis
  • Doing warm-ups before you start exercising
  • Wearing supportive and well-fitting footwear

What is the outlook for tarsal tunnel syndrome?

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The duration of symptoms related to tarsal tunnel syndrome varies on a case-by-case basis. For some patients, symptoms will disappear after receiving treatment for the underlying cause of the condition. You may manage symptoms long term if you have a chronic condition, like arthritis.

It is essential that you promptly treat tarsal tunnel syndrome. Ignoring symptoms may lead to permanent nerve damage. Severe nerve damage may affect your ability to walk, exercise, or complete regular activities. Other possible risks of untreated tarsal tunnel syndrome are:

  • Mild-to-severe foot deformities
  • Partial or complete loss of movement in the toes
  • Partial or complete loss of sensation in the foot or toes

Take a deep breath and start making a plan today. The best way to avoid tarsal tunnel syndrome complications, including receiving incorrect treatment for conditions with similar symptoms, is by speaking with a medical professional as soon as possible.

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