Tarsal Tunnel Syndrome

What is Tarsal Tunnel Syndrome

The ankle is made up of a complex structure of bones, joints, tendons, ligaments, blood vessels, and nerves. On the inner side of the ankle lies a narrow space called the tarsal tunnel. This passage is surrounded by ligaments and acts as a protective channel for structures such as tendons, nerves, and blood vessels that support foot movement and flexibility.

One of the important nerves passing through this tunnel is the posterior tibial nerve. It travels from the back of the lower leg, through the tarsal tunnel near the heel, and continues into the sole of the foot. Tarsal Tunnel Syndrome (TTS) occurs when this nerve becomes compressed within the tunnel, leading to a variety of symptoms.

Symptoms of Tarsal Tunnel Syndrome

People with TTS usually feel discomfort on the inner ankle or the bottom of the foot. The pain can stay in one area or travel along the nerve to the toes, heel, arch, and even up into the calf.

Typical signs and sensations include:

• Pain (sharp, dull, or stabbing)
• Burning feeling
• Tingling or “pins and needles”
• Numbness

The pain may flare up during walking, standing, or wearing certain shoes. Over time, without treatment, the symptoms may become constant and may not go away even during rest.

Diagnosing the Condition

Diagnosing TTS can be tricky because its symptoms often resemble those of plantar fasciitis, another foot condition. While both can cause heel and arch pain, plantar fasciitis involves inflammation or tearing of the ligament along the bottom of the foot, not nerve compression.

To diagnose TTS, a doctor may:

Move the foot and tap near the ankle to see if it recreates symptoms

Feel along the nerve path to check for any growths or masses

Order nerve conduction tests, such as EMG or nerve velocity studies

Use imaging tests like X-rays, MRI, or CT scans for a clearer view

These steps help rule out other issues and confirm the nerve is the source of the problem.

Treatment Options

Initial treatment usually focuses on relieving symptoms without surgery. These may include:

• Resting the foot to help it recover
• Taking anti-inflammatory medications (NSAIDs)
• Using ice packs to reduce pain and swelling
• Wearing supportive shoe inserts (orthotics)
• Switching to more supportive footwear
• Working with a physical therapist on exercises and treatments
• Receiving corticosteroid or anesthetic injections to reduce pain and swelling
• Wearing compression stockings to improve blood flow and reduce swelling

In some cases, a cast or foot brace may be used to immobilize the area and allow healing. If these conservative methods don’t help, surgery—called tarsal tunnel release—might be recommended as a last resort to relieve pressure on the nerve.

Other Possible Treatments:

Joint injections

Detailed diagnostic evaluations

*Pain in the legs or feet can stem from something as simple as overuse or indicate a more serious issue such as a lower back condition. Regardless of the cause, discomfort in these areas can interfere significantly with daily activities.

Possible Causes of Pain

Leg pain can range from the upper thigh to the toes and may originate within the limb itself or be linked to other medical conditions elsewhere in the body. The severity can vary, from minor discomfort to more serious health concerns.

Some frequent causes include:

• Repetitive strain injuries like shin splints, muscle tears, stress fractures, bursitis, or plantar fasciitis
• Muscle cramps or spasms
• Sprains and strains
• Underlying medical conditions affecting bones, the spine, or blood vessels
• Age-related degeneration of tissues
• Injuries and trauma
• Bone fractures, including those from conditions such as osteoporosis
• Inflammation
• Infections
• Genetic predispositions

Common Pain Symptoms

Symptoms that often help in diagnosing the problem include:

• Pain that stays in one area or travels along the leg
• Muscle weakness in the legs
• Limping when walking
• Numbness or pain in the feet
• Tingling or “pins and needles” sensations
• Burning or stabbing types of pain
• Bones that break easily
• Sensitivity to touch
• Difficulty walking or standing for long periods
• Pain that worsens or improves depending on body position

Numbness in the legs or feet is known as peripheral neuropathy, most commonly caused by diabetes. Persistently high blood sugar levels can damage nerves, leading to reduced sensation. Diabetic neuropathy can affect both the upper and lower parts of the legs.

In other cases, infections or pinched nerves may be the cause. Some individuals experience neuropathic pain (distinct from peripheral neuropathy), which includes intense, stabbing pain episodes and lingering numbness or weakness. This type of nerve pain often begins in the lower back or upper thigh and radiates down the leg into the foot.

When to Seek Medical Attention

Severe or ongoing leg and foot pain can become unmanageable and may prompt people to seek professional help. Chronic pain is defined as lasting more than 3 to 6 months. Unfortunately, many delay seeing a doctor until the pain becomes disruptive.

You should consult a medical professional promptly if you notice any of the following:

• Pain continues after several days of rest and home care
• Pain occurs or worsens when walking
• Numbness in any part of the leg or foot
• Swelling in one or both legs or feet
• Difficulty breathing alongside leg or foot pain
• Signs of infection, such as redness or tenderness
• Fever over 100°F
• Increasing intensity of pain

If these symptoms are familiar to you, especially if the pain has become chronic, consider scheduling a visit with a pain specialist at the Spine and Pain Clinic of North America for evaluation and treatment.