Tarsal Tunnel Syndrome: causes, symptoms and treatment

What Causes Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome results from compression of the tibial nerve, and it’s often caused by other conditions, 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 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 experience a tingling or burning sensation inside the ankle or on the bottom of the foot while others experience ankle, toes, arch, and heel pain. Some patients describe a shooting pain.

It is very important to seek proper medical care at the early onset of tarsal tunnel syndrome symptoms. If the condition is left untreated and progresses, it may result in permanent nerve damage.

Diagnosis of Tarsal Tunnel Syndrome

Testing methodologies to diagnose the extent of nerve compression include nerve conduction study, ultrasound, x-rays, and MRI. 

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

A magnetic resonance image (MRI) or ultrasound may be helpful in identifying any soft tissue masses or swelling in the structures in the tarsal tunnel that may be compressing the nerve.

Conservative Treatment of Tarsal Tunnel Syndrome

If compression is minimal, your physician may attempt conservative care, such as: 

• Physical therapy
• Custom orthotics or braces
• Rest
• Casting
• Anti-inflammatory medications

If these less-invasive methods fail to solve the compression, your doctor may suggest 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 other symptoms. Tarsal tunnel surgery is conducted to relieve pressure on the posterior tibial nerve and its branches.

To decompress the nerve in the tarsal tunnel, an incision is made 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. The nerves are then released. Your 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 Medtronic intraoperative nerve-testing machine at the time of tarsal tunnel release. Testing ensures that compression is caught and removed.

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 surgery, a bulky dressing is applied to the foot to keep the leg from moving and minimize swelling in case of weight-bearing. The dressing typically remains on for about a week. Most people use crutches for the first three weeks. Heavier or older patients may use a walker.

Sutures are left on for three weeks for the skin to regain 90 percent of its original strength. We want the nerves to glide post-operatively, so it is critical during the 2nd and 3rd weeks following the surgery that the posterior tibial nerve and its branches are able to move in the tunnels.

An air cast is applied to the ankle has some range of motion and toe movement so the nerves do not become adherent to the surrounding tissue.

Why UFAI is the Best Choice for Foot and Ankle Care

Accurate diagnosis of tarsal tunnel 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.