The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament that protects and maintains the structures contained within the tunnel—arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome.
Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.
Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.
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Causes of Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as:
- A person with flat feet is at risk for developing tarsal tunnel syndrome, because the outward tilting of the heel that occurs with “fallen” arches can produce strain and compression on the nerve.
- An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon, and arthritic bone spur.
- An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
- Systemic diseases such as diabetes or arthritis can cause swelling, thus compressing the nerve.
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Symptoms of Tarsal Tunnel Syndrome
Patients with tarsal tunnel syndrome experience one or more of the following symptoms:
- Symptoms are typically felt on the inside of the ankle and/or on the bottom of the foot. In some people, a symptom may be isolated and occur in just one spot. In others, it may extend to the heel, arch, toes, and even the calf.
- Pain, including shooting pain in and around ankles and sometimes the toes
- Tingling, burning, or a sensation similar to an electrical shock in and around ankles and sometimes the toes
- Numbness in and around ankles and sometimes the toes
- Swelling of the feet
Sometimes the symptoms of the syndrome appear suddenly. Often they are brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising, or beginning a new exercise program.
It is very important to seek early treatment by our foot and ankle Chartered Physiotherapist if any of the symptoms of tarsal tunnel syndrome occur. If left untreated, the condition progresses and may result in permanent nerve damage. In addition, because the symptoms of tarsal tunnel syndrome can be confused with other conditions, proper evaluation is essential so that a correct diagnosis can be made and appropriate treatment initiated.
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Treatment of Tarsal Tunnel Syndrome
Our Physios will examine the foot to arrive at a diagnosis and determine if there is any loss of feeling. During this examination, the surgeon will position the foot and tap on the nerve to see if the symptoms can be reproduced. He or she will also press on the area to help determine if a small mass is present.
A variety of treatment options, often used in combination, are available to treat tarsal tunnel syndrome. These include:
Immobilization Restricting movement of the foot by Taping & Strapping is sometimes necessary to enable the nerve and surrounding tissue to heal.
Electrotherapy Electrotherapy including ultrasound therapy may be used to reduce symptoms.
Exercise Exercises may be prescribed to reduce symptoms.
Orthotic devices To help maintain the arch and limit excessive motion that can cause compression of the nerve, we may prescribe either off the shelf corrective insoles or customised orthotics, which we manufacture bespoke for you using our Gait Scan technology. For full details on this service, click here
Shoes Supportive shoes may be recommended.
If we suspect a mass or if initial treatment does not reduce the symptoms, we will immediately refer you on for advanced imaging.
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When is Surgery Needed?
Sometimes surgery is the best option for treating tarsal tunnel syndrome. If we believe this to be the case, we will refer you on to a foot and ankle consultant who will determine if surgery is necessary and will select the appropriate procedure or procedures based on the cause of the condition.
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