Tarsal tunnel syndrome is a condition that can cause pain with every step you take. Tarsal tunnel, similar to carpal tunnel in the wrist, is a compressed or pinched nerve that occurs at the inside of the ankle. Symptoms can occur at the ankle, the heel and even the bottom of the foot. 

The tibial nerve is a nerve that travels down the inside of your ankle and under a flat ligament called the flexor retinaculum and then to the bottom of your foot. When this nerve becomes pinched, as it travels under this ligament, it results in tarsal tunnel syndrome. Diabetes, flat feet or fallen arches, varicose veins, arthritis and chronic ankle sprains can be contributing and causative factors of tarsal tunnel syndrome. This can lead to inflammation and irritation of the nerve, which can cause burning, tingling and numbness. 

Pain can lead to dysfunction when performing daily activities, such as limping or gait abnormalities. In turn, gait abnormalities can lead to pain in the lower back, hips, knees and ankle. Some patients will report their symptoms worsening during sleep and certain activities, such as standing for extended periods of time.

Treatment of tarsal tunnel syndrome depends on the severity of the patient’s syndrome. Often, providers will order a test called an electromyography (EMG) and/or a nerve conduction velocity (NCV) to help confirm the diagnosis and determine the level of severity. Providers may also order X-rays, CT scans or MRIs to help rule out other diagnoses. Nonsurgical treatment may consist of oral anti-inflammatories or steroids, topical anti-inflammatory cream, physical therapy, bracing and injections.

Surgical intervention is typically recommended when a patient’s condition is categorized as moderate to severe and/or the nonsurgical treatment has failed to reduce symptoms. Surgery consists of removing anything compressing the nerve including the tight ligament and any cysts or veins that may be in the area. Patients typically have to be completely non weight bearing for two weeks while their incision heals and they are, then, able to start physical therapy after that.

If you are concerned that you may have tarsal tunnel syndrome, talk to your orthopedic/podiatric provider today.