Have you just been diagnosed with tarsal tunnel syndrome or you think you may have it because of pain and sensory problems in your foot?
I will answer some of the common questions based on my knowledge as a diagnostic radiographer and on academic medical studies on the subject.
Happy reading!😃
All references at the end of this article, let’s meet in the comments section🙏
Last updated: Dec 2024. Written by Juliet Semakula, diagnostic radiographer.
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▶️What is tarsal tunnel syndrome?
A tarsal tunnel syndrome is a condition that occurs when you damage or compress the tibial nerve in your ankle to the bottom of the foot.
This tibial nerve runs through the tarsal tunnel, a passage in your ankle made up of bones and ligaments.
If this canal is narrowed or compressed, your nerve may be affected. You may feel pain, numbness or tingling in your foot.
Common sites of heel pain with corresponding diagnoses.
Image retrieved: Diagnosis of heel pain. Am Fam Physician. 2011;84(8):912.
▶️What can be confused with tarsal tunnel syndrome?
Usually, the symptoms of the tarsal tunnel syndrome are confused by other foot/ankle problems such as:
♦Plantar fasciitis is pain on the bottom of your foot, around your heel and arch caused by anything that puts pressure on your feet.
♦Morton’s neuroma is a thickening of the tissue that surrounds the digital nerve leading to the toes. This thickening can lead to various levels of pain or discomfort in the forefoot that may limit your mobility.
It is important to get a proper diagnosis for tarsal tunnel syndrome because these foot issues have some symptoms with tarsal tunnel syndrome.
▶️What really causes tarsal tunnel syndrome?
The cause of a tarsal tunnel syndrome is anything that can create a compression of the tibial nerve or its terminal branches.
Often the cause is unknown with a possible gradual progression of symptoms
When you go to the doctor with a suspected tarsal tunnel syndrome, an evaluation will be done to look at intrinsic or extrinsic causes of the compression such as
🟢Anatomic abnormalities such as tarsal coalition and middle facet
🟢Biomechanical abnormalities such as valgus rear foot.
🟢Post operation issues on the foot.
🟢Arteriopathy of the lower limbs
🟢Generalised Oedema of the lower limb.
Nelson 2021
Tarsal tunnel syndrome can be triggered by several things:
🟢Osteophytes associated with ankle osteoarthritis.
🟢Inflammation of tendon passing through the tendonitis.
🟢Varicose veins, cysts, lipomas and neuromas that compress the area.
An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
▶️How is tarsal tunnel syndrome diagnosed?
Evaluation of the physical and biomechanical of your medical history will be done.
MRI is the preferred and other diagnostic test for tarsal tunnel syndrome, also an ultrasonography, electromyography, and nerve conduction studies may also be useful
▶️What symptoms will you have with tarsal tunnel syndrome?
Patients with tarsal tunnel syndrome often report worsening of pain with standing, walking, or running.
🟡You will feel tingling, burning, or numbness in the sole of the foot
🟡You may feel pain or cramp in the sole of the foot
🟡Pain may mainly occur at night, after exercise or at rest
🟡Muscular atrophy or weakness in the foot.
▶️What does tibial nerve pain feel like for a tarsal tunnel syndrome?
You may feel cramping or tightness sensation like pins and needles in the foot, making movement difficult
This can cause numbness, burning and tingling into the foot. It may also cause a generalised ache that is hard to describe.
▶️How do you treat tarsal tunnel syndrome?
The main goal of treatment will be to help decrease pain, inflammation and relieve the compressive forces on the tibial nerve.
However, management of tarsal tunnel syndrome remains challenging because of many intervention strategies but limited robust evidence.
Uncertainties still exist about the best conservative treatment timing of surgical intervention, and best surgical approach.
Here are some of the management options available.
Conservative method
The first option of treatment will be conservative method. You will be advised to rest your foot along with icing, compression, and elevation (R.I.C.E method) to help alleviate swelling and inflammation.
You doctor will suggest
Physiotherapy, exercise and orthotics, insoles.
After an assessment your physiotherapy can propose different types of treatment depending on your general health and discomfort.
Your physical therapist may recommend the following exercises to help prevent pronation or rolling of the foot and help with muscle strengthening or stretching.
🟡 Heel-toe raises
🟡Balance exercises
🟡Pencil-toe lifts
🟡Ankle pumping exercises
Here is a you tube video from Ask DoctorJo showing these movements.
Physio will recommend short term pain relief such as shockwave, TENS and cryotherapy.
Putting a heating pad on the inside of your ankle may also help increase circulation to the pinched nerve and relieve pain.
Your podiatrist may recommend insole or heel cup footwear if in your case you need to.
The right shoes feature a combination of extra depth, firm midsoles and outer soles that allow for bending of the toes, low heel and firm heel counters that wrap around the heel to restrict abnormal foot motion the foot will ideal.
The idea is to rehabilitate your foot and, more generally, your various muscular, tendinous and bony structures, so that they can tolerate greater stress.
Wearing a splint or compression socks on your foot at night will keep your foot in a stretched position. This can help to relieve pressure on the nerve and ease symptoms.
Medication to help with your pain.
🟡You may be given pain medications such as paracetamol, NSAIDs, or sometimes those more commonly prescribed for pain of neurological origin: gabapentin, pregabalin and tricyclic antidepressants.
🟡Corticosteroid injections and platelet-rich plasma injections can help reduce pain temporary.
Messages to the affected foot will also be used to provide short term pain relief.
Surgical option
Surgery can be considered if conservative measures are ineffective.
A surgical release of the tibial nerve and its terminal branches can help in relieving the pain.
Here a band of tissue called the flexor retinaculum which attaches near the inside of the ankle to release the compressed nerve.
Overall, the results of surgical treatment for tarsal tunnel have shown improving results.
According to the available data, the people most likely to respond better to better to surgery are those who
1️⃣Are younger
2️⃣Have been hurting for less time
3️⃣Have no other ankle issues
4️⃣Have a positive Tinel sign before surgery.
Studies have shown that surgical release improves or resolves symptoms of tarsal tunnel syndrome in 85% to 90% of cases.
(Reade 2001)
We can imagine that people with the four points have a better prognosis whatever they do, even without surgery.
Patients who undergo tarsal tunnel syndrome surgery must be informed that the operation may not yield a completely satisfactory result
▶️Does tarsal tunnel syndrome go away on its own?
If left untreated, tarsal tunnel syndrome can cause permanent nerve damage.
♦Deformity of the foot (mild to severe)
♦Movement loss in the toes (partial or complete)
♦Repeated or unnoticed injury to the leg.
▶️How long does it take for tarsal tunnel syndrome to go away?
Some patients have reported immediate relief of their tarsal tunnel symptoms for example numbness, tingling, burning, shooting sensations following surgery (Reade 2001).
Others may take up to 6 months to a year to see the same improvements.
This depends on the severity of your tarsal tunnel syndrome and the length of time it has been present.
▶️Is walking bad for the tarsal tunnel?
You may feel a burning or tingling pain in the sole of the foot when you try to walk or during certain activities.
Pain typically worsening with activities such as standing or walking for extended periods.
So, walking will depend on how you feel when you put pressure on your feet. You can start gradually when you feel you have rested it enough and the pain and swelling have subsidized
▶️Can you drive with tarsal tunnel syndrome?
The interference with driving is variable, depending on the severity and pain of your tarsal tunnel syndrome.
Before driving you can test yourself by sitting in the driver seat, then try to put pressure on the pedals if you feel pain or any discomfort then you are not ready to drive.
The tarsal tunnel syndrome can cause loss of force in the foot movements necessary for driving, there is a risk of accident if the pedals are not well pressed.
We have come to the end of this article; hope I have answered some of your questions.
Wishing you a quick recovery!🙋
📚Source:
Nelson SC. Tarsal Tunnel Syndrome. Clin Podiatr Med Surg. 2021 Apr;38(2):131-141. doi: 10.1016/j.cpm.2020.12.001. PMID: 33745647.
Tu P. Heel Pain: Diagnosis and Management. Am Fam Physician. 2018 Jan 15;97(2):86-93. PMID: 29365222.
McSweeney SC, Cichero M. Tarsal tunnel syndrome-A narrative literature review. Foot (Edinb). 2015 Dec;25(4):244-50. doi: 10.1016/j.foot.2015.08.008. Epub 2015 Sep 12. PMID: 26546070.
Reade BM, Longo DC, Keller MC. Tarsal tunnel syndrome. Clin Podiatr Med Surg. 2001 Jul;18(3):395-408. PMID: 11499170.
Kokubo R, Kim K, Isu T, Morimoto D, Morita A. Patient Satisfaction with Surgery for Tarsal- and Carpal- Tunnel Syndrome – Comparative Study. Neurol Med Chir (Tokyo). 2023 Mar 15;63(3):116-121. doi: 10.2176/jns-nmc.2022-0245. Epub 2023 Jan 20. PMID: 36682791; PMCID: PMC10072891.