Tarsal Tunnel Syndrome

The tarsal tunnel is a narrow passage on the inside of the ankle, formed by the bones and surrounding tissues. The tarsal tunnel contains the posterior tibial nerve, major nerve responsible for sensation and motor function in the foot.

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Overview

Tarsal tunnel syndrome is a form of nerve entrapment in the ankle that occurs when excessive pressure is placed on the posterior tibial nerve as it passes through a passage called the tarsal tunnel. This is a condition that occurs when the nerve that runs through the ankle is compressed, causing pain, numbness, and weakness in the foot.

Causes

Tarsal tunnel syndrome can be attributed to various factors, such as:

  • Individuals with flat feet or feet hypermobility
  • Repetitive stress, overuse or injury
  • Foot and ankle misalignment
  • Direct compression from mass lesions such as varicose veins, cysts and tumours
  • Injury and inflammation resulting in swelling around the nerves

Pain that initially presents itself in one foot can also occur in the other foot as the person tries to alter their weight distribution to minimise existing pain.

Risk factors

There are several factors that increase the likelihood of developing tarsal tunnel syndrome. Individuals who have made sudden changes to their daily activities or who are predisposed to foot and ankle misalignment may experience the onset and development of tarsal tunnel syndrome to occur over a short period of time. Patients who have had multiple ankle sprains are also at risk for developing tarsal tunnel syndrome.

Symptoms

Tarsal tunnel syndrome is often mistaken for plantar fasciitis as both conditions occur in the same region of the foot. Unlike plantar fasciitis, tarsal tunnel syndrome includes neurological symptoms such as numbness or tingling that extends to the heel, toes, or arch. Key symptoms include:

  • Pain radiating into the arch and heel of the foot, and occasionally the toes.
  • Burning or tingling sensation similar to pins and needles
  • Numbness or reduced feeling in the foot

Pain can be aggravated when running or standing for long periods of time and individuals may experience increased pain, particularly at night.

Diagnosis

A podiatrist will conduct a comprehensive assessment of your foot and ankle to accurately determine the condition. Clinical imaging along with a hands-on assessment ensures an accurate diagnosis is made, enabling your podiatrist to develop a suitable plan for your specific needs.

This is particularly important as tarsal tunnel syndrome can be easily mistaken for plantar fasciitis, which highlights the importance of seeking a professional diagnosis.

How can Tarsal Tunnel Syndrome be managed?

Podiatrists utilise non-invasive methods, such as Electromagnetic Transduction Therapy (EMTT) and Super Inductive System (SIS) to reduce pain and symptoms associated with nerve irritation and long-term damage, including scarring.

Customised foot orthotics or ankle-foot orthotics can help to offload specific areas of the foot, reducing overpronation, and increasing stability to alleviate nerve compression.

It is crucial to address tarsal tunnel syndrome promptly, as neglecting it may result in permanent nerve damage. Exploring conservative options, including advanced podiatric interventions, is advisable before considering surgery.

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Common Symptoms

Radiating pain in the arch and heel of the foot, and occasionally the toes
Numbness
Worsened pain when running or standing for long periods
Pain can be more intense at night

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An ankle specialist, such as a podiatrist, will be able to perform a thorough foot assessment using diagnostic tools, such as a musculoskeletal diagnostic ultrasound to determine the source of your ankle pain. If surgery is required, your podiatrist will refer you to a trusted foot and ankle doctor for surgical solutions.

A thorough assessment of your ankle

Immobilising the area with splints

Utilising technological therapies

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