Tarsal Tunnel Syndrome: Symptoms, Causes, Treatment, Exercises

Key Takeaways

• Tarsal tunnel syndrome is caused by compression of the posterior tibial nerve, leading to foot pain, tingling, and numbness.

• Common symptoms include burning sensations, swelling, and difficulty walking.

• Main causes include ankle injuries, flat feet, and certain systemic diseases like diabetes.

• Diagnosis often involves physical exams, imaging tests, and nerve conduction studies.

• At MSK Doctors, we use innovative technological methods to analyse your unique movement patterns, enabling our orthopaedic consultants to develop precise and personalised treatment approaches.

Tarsal Tunnel Syndrome Overview

Tarsal tunnel syndrome is essentially the result of pressure on the posterior tibial nerve, which runs along the inside of the ankle into the foot (image courtesy of Premier Podiatry).

When this nerve is compressed, it can cause a variety of symptoms that affect daily activities. Think of it like a garden hose - if you step on it, the water flow decreases. Similarly, when the nerve is compressed, its function is impaired.

Common Symptoms

Tarsal tunnel syndrome manifests through a distinctive pattern of discomfort and sensory disturbances primarily affecting the foot and ankle region. 

• Individuals with this condition frequently experience burning sensations that radiate from the inside of the ankle and extend throughout the sole of the foot. 

• This burning discomfort is often accompanied by tingling or "pins and needles" sensations that can be particularly pronounced in the heel, arch, and toes. 

• Numbness represents another common symptom, with patients describing patches of reduced sensation across the plantar surface of the foot. This numbness can progress from intermittent to persistent as the condition advances, potentially affecting proprioception and balance.

• Visible swelling around the ankle, particularly along the medial (inner) aspect where the tibial nerve passes through the tarsal tunnel, serves as both a symptom and a contributing factor that may exacerbate nerve compression. 

Walking difficulties represent a functional consequence of these symptoms, with patients frequently causing one to walk with a limp to minimise pressure on affected areas. 

This can lead to secondary issues in the musculoskeletal chain, potentially affecting the knees, hips, and lower back over time.

Main Causes

Traumatic Injuries

• Ankle injuries play a significant role in the development of tarsal tunnel syndrome. Acute traumatic events such as ankle sprains, particularly those involving inversion (rolling inward), can initiate inflammatory responses that directly impact the tarsal tunnel region. 

• Fractures around the ankle, especially those involving the medial malleolus or calcaneus (heel bone), can likewise contribute to nerve compression through both direct mechanical pressure and secondary inflammatory processes. 

Biomechanical Factors

• Flatfeet deformity (pes planus) represents one of the most significant biomechanical risk factors for developing tarsal tunnel syndrome. When the medial longitudinal arch collapses, it creates abnormal tension and stretching of the tibial nerve as it courses through the tarsal tunnel. 

• High-arched feet (pes cavus) can also predispose individuals to this condition through different mechanical pathways, creating increased pressure points at specific locations along the nerve's path. 

Systemic Medical Conditions

• Diabetes mellitus increases the risk of developing tarsal tunnel syndrome through multiple mechanisms. Diabetic neuropathy itself makes the tibial nerve more vulnerable to compression, while diabetes-related microvascular changes can compromise nerve blood supply. 

• Inflammatory arthritis conditions, particularly rheumatoid arthritis, can affect the tarsal tunnel through synovial inflammation and proliferation within adjacent joints and tendon sheaths. The resulting tissue hypertrophy and fluid accumulation can impinge upon the tibial nerve as it traverses through the already confined tarsal tunnel space.

Vascular Factors

• Varicose veins around the ankle region pose another significant risk factor. These enlarged, tortuous venous structures can directly compress the tibial nerve or contribute to increased pressure within the tarsal tunnel compartment. 

• Arteriovenous malformations, though rare, can similarly occupy space within or adjacent to the tarsal tunnel, leading to nerve compression. These vascular abnormalities may gradually enlarge over time, causing progressive worsening of symptoms.

Diagnosis and Treatment Options

Steps for Diagnosis

Imaging tests like X-rays, MRIs, or ultrasounds might be used to visualise the structures around the nerve. Nerve conduction studies can also help determine how well electrical signals are traveling through the nerve.

Conservative Treatment Methods

Rest and immobilisation can help reduce inflammation. Ice packs applied to the affected area can also alleviate swelling and pain. In some situations, doctors recommend orthotic devices to support the foot and reduce pressure on the nerve.

Footwear Recommendations

Wearing the right footwear matters in preventing and managing tarsal tunnel syndrome. Shoes that provide adequate support and cushioning can help reduce pressure on the nerve.

Look for shoes with:

• Good arch support to prevent overpronation.

• Cushioned soles to absorb shock.

• A wide toe box to allow your toes to move freely.

Consider consulting with a podiatrist for personalised footwear recommendations, especially if you have unique foot structure concerns.

Daily Foot Care

Regular foot care routines can significantly impact your overall foot health and prevent complications from tarsal tunnel syndrome. 

• Keep your feet clean and dry to prevent infections.

• Moisturise to prevent dry, cracked skin.

• Perform regular self-checks for any signs of swelling or discoloration.

Taking a few minutes each day for foot care can go a long way in keeping your feet healthy and pain-free.

Lifestyle Adjustments

Consider these lifestyle changes:

• Maintain a healthy weight to reduce pressure on your feet.

• Incorporate regular, low-impact exercise to improve circulation.

• Avoid standing for prolonged periods without breaks.

Effective Exercises

Calf Stretch

Calf stretches are vital because they help improve flexibility and relieve tension in the lower leg muscles. When these muscles are tight, they can contribute to nerve compression.

To perform a calf stretch:

• Stand facing a wall, with your hands placed on the wall at shoulder height.

• Step one foot back, keeping it straight, and bend the front knee.

• Press your back heel into the ground and hold the stretch for 15-30 seconds.

• Switch legs and repeat.

Ankle Mobilisation

Ankle mobilisation exercises help improve the range of motion and reduce stiffness. These exercises are beneficial for maintaining joint flexibility and preventing further injury.

Try this simple ankle mobilisation exercise:

• Sit on a chair with your feet flat on the ground.

• Lift one foot and gently rotate your ankle in a circular motion, clockwise and counterclockwise.

• Perform 10 rotations in each direction, then switch to the other foot.

Foot Flexibility Drills

Improving foot flexibility can help distribute weight more evenly and reduce stress on the tarsal tunnel. These drills can be done anywhere and require no special equipment.

Here's a simple foot flexibility drill:

• Sit comfortably and place a towel on the floor in front of you.

• Using your toes, scrunch the towel towards you, then push it away.

• Repeat this motion 10-15 times with each foot.

Your Path To Better Foot Health With MSK Doctors

At MSK Doctors, we understand the debilitating impact tarsal tunnel syndrome can have on your daily activities and overall well being. 

Our team of specialist orthopaedic consultants approaches each case with meticulous attention to detail, using our exclusive MAI Motion AI platform to analyse your unique movement patterns and identify the specific biomechanical factors contributing to your condition. 

This precision diagnostics enables us to develop highly individualised treatment plans that address not just your symptoms but the underlying causes. 

What sets us apart from traditional pathways requiring lengthy GP referrals is that we offer direct access to specialist care, comprehensive treatment options ranging from custom orthotics and targeted physiotherapy to advanced regenerative treatments when necessary. 

With a proven track record of helping patients return to pain-free mobility and the activities they love, we are here to help get you back to tip top shape too!

Book your consultation with MSK Doctors today for direct access to specialist care without GP referral and discover our comprehensive approach to treating tarsal tunnel syndrome.

Frequently Asked Questions (FAQ)

What is the quickest way to relieve tarsal tunnel pain?

Applying ice to the affected area for 15-20 minutes can quickly reduce inflammation and numb the pain. Elevating the foot and using over-the-counter pain relievers like ibuprofen can also provide fast relief. 

Are there any home remedies for tarsal tunnel syndrome?

One effective home remedy to manage tarsal tunnel syndrome symptoms is to perform regular stretching exercises, such as calf stretches and ankle rotations. This helps to maintain flexibility and reduce tension around the nerve. 

How can I strengthen my foot muscles?

Toe curls and towel scrunches are simple exercises that target the intrinsic muscles of the foot. To perform toe curls, sit with your feet flat on the floor and curl your toes inward, holding the position for a few seconds before releasing.

Is surgery always necessary for tarsal tunnel syndrome?

Surgery is not always necessary for tarsal tunnel syndrome. In fact, most cases can be effectively managed with conservative treatments, such as physical therapy, orthotics, and lifestyle modifications. 

Can MSK Doctors help with my tarsal tunnel syndrome?

Absolutely! At MSKDoctors, we are committed to providing comprehensive care for individuals with tarsal tunnel syndrome. Our team of experts will work closely with you to develop a personalised treatment plan that addresses your unique needs.