Tarsal Tunnel Syndrome: causes, symptoms and treatment

What causes tarsal tunnel syndrome? 

Tarsal tunnel syndrome is a form of neuropathy (nerve damage) that results from the squeezing of the tibial nerve. Common causes of tarsal tunnel syndrome include other conditions of the feet and ankles, such as:

• Flat feet, which can stretch the tibial nerve.
• Bony growths in the tarsal tunnel.
• Varicose veins surrounding the tibial nerve can cause nerve compression.
• Inflammation from rheumatoid arthritis.
• Lesions and masses such as ganglion cysts or tumors near the tibial nerve.
• Inflammation and swelling from an ankle sprain or fracture.
• Diabetes makes the nerve more vulnerable to compression.

What are the symptoms of tarsal tunnel syndrome?

Many patients with TTS experience a tingling or burning sensation along the tarsal tunnel. Discomfort can run from the inside of the ankle down to the arch of the foot. While pain is often limited to the ankle and the bottom of the foot, other individuals can experience heel pain, and pain in their toes. The severity and sensation of foot pain associated with TTS can range from numbness to burning, tingling, or shooting pain akin to an electrical shock.

It is very important to seek attention from our healthcare providers at the onset of symptoms in order to diagnose or rule out tarsal tunnel syndrome. When caught and treated early, we have many conservative treatment options. However, if the condition is left to progress untreated, it can result in permanent nerve damage.

How do the podiatrists at University Foot & Ankle Institute diagnose tarsal tunnel syndrome? 

At UFAI, we have access to nerve conduction studies, ultrasound, X-rays, and MRIs to diagnose the extent of your nerve compression.

A nerve conduction study is typically used in cases of neuralgia to ensure that a peripheral nerve, like those in the tarsal tunnel, is working correctly. Mild electrical stimulation is provided to the nerve during the procedure, known as electromyography (EMG). Electrodes, placed at varying points along the nerve, check for dysfunction by recording the speed and strength of the current as well as the resulting muscle movement.

The test is different than imaging tests like an X-ray or MRI, which show us if any of the soft tissue, bones, or ligaments are impinging on the space occupying the peripheral nerves.

In some cases, electrical stimulation may not be needed. Our podiatrist may use Tinel’s test, in which we manually tap on the tarsal tunnel. If this action causes pain or tingling, it is a Tinel sign that TTS is likely present. Similarly, dorsiflexion eversion (pushing the ball of the foot toward the shin) that produces symptoms can also point to TTS.

At UFAI, we occasionally see patients who have been previously misdiagnosed with plantar fasciitis or bone spurs. Our physicians have decades of combined experience and the latest tarsal tunnel syndrome testing equipment available for the most accurate diagnosis.

What are conservative treatments for tarsal tunnel syndrome? 

If compression is minimal, we can attempt nonsurgical treatment, such as:

• Physical therapy
• Custom orthotics or orthopedic braces and splints
• Rest
• Casting and immobilization
• Nonsteroidal anti-inflammatory medications (NSAIDs)
• Steroid injections (corticosteroid injections)

If these less-invasive methods fail to solve the compression, we may have to turn to surgical intervention.

Tarsal tunnel syndrome surgery 

A tarsal tunnel syndrome surgical procedure should only be considered if all non-operative treatment options have been unsuccessful at relieving pain and providing for decompression of the nerve.

To decompress the nerve in the tarsal tunnel, we make an incision behind the ankle bone and toward the bottom of the foot. The posterior tibial nerve is separated from the artery and vein and then followed into the tunnel, often to its narrowest point, where it meets the abductor hallucis muscle toward the bottom of your foot. Here, it splits into two primary branches: the medial plantar and the lateral plantar nerve. If either are affected, it could lead to heel or toe pain respectively. The nerves are then released from impingement.

Our doctor will also look for cysts and other nerve blockage problems that may need correction. If there is scarring within the nerve or branches, the outer layer of nerve wrapping is opened and scar tissue removed.

We utilize the state-of-the-art Medtronic intraoperative nerve-testing machine at the time of tarsal tunnel release. Testing ensures that compression is caught and remedied. This intra-operative testing is only available in select locations in the United States, including the University Foot and Ankle Institute.

What to expect after tarsal tunnel syndrome surgery

During ankle surgery, a bulky dressing is applied to the foot to keep the leg from moving and minimize swelling during weight-bearing. The dressing typically remains on for about a week. Most people use crutches for the first three weeks and have to limit physical activity to allow the foot to heal.

Sutures are left on for three weeks until the skin regains 90% of its original strength. We want the nerves to glide post-operatively, so it is critical during the second and third weeks following the surgery that the posterior tibial nerve and its branches are able to move freely in the tunnels. To facilitate this, an air cast is used instead of a rigid cast as it allows some range of motion and movement of the toes so the nerves do not adhere to the surrounding tissue.

Why UFAI is the best choice for foot and ankle care

Accurate diagnosis of tarsal tunnel syndrome is crucial to stopping further damage. With decades of experience armed with state-of-the-art testing techniques, we can ensure a pinpoint diagnosis.

The physicians at UFAI are internationally recognized foot and ankle specialists. They use the latest technologies and treatment options available in a comfortable and family-friendly environment. New patients or individuals concerned about foot or ankle symptoms in the greater Los Angeles area are encouraged to call or schedule a consultation; please call (877) 736-6001 or make an appointment now.

University Foot and Ankle Institute medical centers are conveniently located throughout Southern California with podiatry clinics in (or near) Santa Monica (on Wilshire Blvd.), Los Angeles, Beverly Hills, West Los Angeles, Sherman Oaks, and the San Fernando Valley, Manhattan Beach, and the South Bay, LAX, Westlake Village, Valencia, Santa Clarita, and Santa Barbara. 

 

 

Tarsal tunnel syndrome FAQs 

 

How long does tarsal tunnel syndrome last?

Tarsal tunnel syndrome cannot go away on its own. Symptoms can be managed with therapy and medication. Curing tarsal tunnel syndrome involves treating the underlying condition and decompressing the nerve.

 

Can you have carpal tunnel and tarsal tunnel at the same time?

Carpal tunnel and tarsal tunnel syndrome are two different conditions, with the former affecting the wrist and hand and the latter affecting the ankle and foot. However, research has shown that individuals who are prone to a narrow carpal tunnel may be more likely to have a narrow tarsal tunnel, increasing the likelihood of developing both conditions, potentially at the same time.

 

What can be mistaken for tarsal tunnel syndrome?

Tarsal tunnel syndrome symptoms can sometimes be misdiagnosed, instead believed to be caused by plantar fasciitis, Achilles tendonitis, or a heel (calcaneal) bone spur.

 

Sources

Tarsal tunnel syndrome—A narrative literature review - ScienceDirect https://doi.org/10.1016/j.foot.2015.08.008

Tarsal Tunnel Syndrome: A Review of the Literature - John T.C. Lau, Tim R. Daniels, 1999 https://doi.org/10.1177/107110079902000312 MR

Imaging of Entrapment Neuropathies of the Lower Extremity | RadioGraphics https://doi.org/10.1148/rg.304095188