Tarsal tunnel syndrome is an impingement syndrome affecting the inside of the foot and ankle that can produce numbness, pain,
tingling, or burning sensations throughout the foot.
The posterior tibial nerve is a major nerve that runs down the inside of your leg and crosses the inside of your ankle
where it branches off to give feeling to different areas of your foot. As it crosses the inside of the ankle, it passes through a dedicated
space called the tarsal tunnel, named after the tarsal bones of the foot where the tunnel is located.
When the space inside the tarsal tunnel is reduced, which can be the result of various injuries, diseases or biomechanical factors, the nerve can become compressed or pinched. It is this compression that produces symptoms that can affect the entire foot and even the lower leg, though they tend to be more prominent on the bottom of the foot and the inside of the ankle.
The compression or pressure on the posterior tibial nerve can be caused by anything that reduces the space available within the tarsal tunnel. This means that the causes can vary greatly, but may include:
As the key to treating tarsal tunnel syndrome is identifying and managing the cause, having an appointment with your podiatrist for a biomechanical assessment is highly recommended and should be completed as early as possible.
Interestingly, research shows that up to 43% of patients with tarsal tunnel syndrome have a history of trauma including events such as ankle sprains. Abnormal foot biomechanics also contributes to disease progression, as does having hypothyroidism, gout, hyperlipidemia, certain metabolic diseases, and diabetes.
When tarsal tunnel syndrome is left untreated and the nerve continues to be compressed, there’s a risk of developing permanent nerve damage that can make it more difficult for you to walk and exercise. It’s important to treat tarsal tunnel promptly.
Your podiatrist is able to diagnose tarsal tunnel syndrome based on your medical history, injury history, and a clinical assessment to understand which movements compress the nerve and produce your symptoms. For those whose symptoms are a result of their foot posture, we often find the symptoms are easily reproduced by moving the foot outwards which stretches the nerve, and the symptoms resolve when we turn the foot to face it inwards, which creates more of an ‘arched’ foot shape. Where the cause is unable to be determined clinically, we may refer you for an x-ray or ultrasound to look for any masses like cysts that may be present in or near the tunnel.
In order to effectively treat tarsal tunnel syndrome, we must address the cause of the impingement to prevent ongoing nerve compression. Before you’re able to get in to see your podiatrist, try your best to avoid any movements that exacerbate your symptoms. Many people may try using ice or non-steroidal anti-inflammatories (NSAIDs) to help manage their pain, but you should note that for some this may not be very successful, particularly if the cause is mechanical in nature. It’s a good idea to take notes of exactly which movements and positions produce symptoms, as this will give valuable information to your podiatrist to use in their assessment.
When it comes to podiatric management of tarsal tunnel in our clinic, we may use:
This generally depends on the cause of your tarsal tunnel syndrome. If your cause is due to an injury that causes swelling in or around the tunnel, or it’s from a mass in the tunnel, then once the problem is treated or removed, it generally won’t return unless you sustain a new injury or develop a new mass. For causes like generalised joint space narrowing through arthritic or other changes, you may notice your symptoms return if you stop wearing your orthotics, if, for example, this is the primary way you’re supporting that joint space to stay open.
This depends on the cause of your tarsal tunnel syndrome, but generally speaking, once the cause is addressed and treated, symptoms tend to disappear very quickly as there is nothing to compress or irritate the nerve. This may be more difficult when the cause is related to something like degenerative arthritis, as it may pose ongoing challenges or recurrences based on things like your footwear selection, whether you’re wearing your orthotics, and more.
As tarsal tunnel syndrome can have a variety of causes, there’s no single way to prevent it completely. However, you can help reduce your risk by wearing well-fitted, supportive footwear as much as possible, particularly if you’re active or have a flatter foot posture. If you have orthotics from a podiatrist already, wearing these regularly can also help reduce your risk by optimising your foot posture. Managing any foot and ankle injuries before they progress and worsen can also help reduce your risk of further problems including tarsal tunnel syndrome.
Yes, most people are still able to walk with their tarsal tunnel symptoms, but it may become much less comfortable or more painful, and engaging in exercise may become more difficult.
Sometimes, but sometimes not. This really depends on the cause of your tarsal tunnel syndrome. For example, where a flatter foot posture
causes nerve compression and irritation, having your feet up, relaxed and rested at night may actually ease your symptoms.
Yes, without taking the right steps to relieve the nerve compression or irritation, your symptoms will continue and may worsen, increasing your pain or discomfort.