You have likely heard a lot about carpal tunnel syndrome, which can leave you with numbness or tingling in your wrists and fingers. But did you know that a similar condition, called tarsal tunnel syndrome, could take an equally uncomfortable toll on your feet and ankles? Let’s take a closer look at what causes tarsal tunnel, and what we can do to prevent and treat it.

What Causes Tarsal Tunnel Syndrome?  

Tarsal tunnel syndrome is characterized by pain in your ankle, foot, and sometimes in your toes. It develops when the nerve that serves your heel and sole (postYour arch height, and your foot's tendency to pronation or supination, can increase your risk for tarsal tunnel syndromeerior tibial) becomes compressed or damaged.

How does that damage typically occur? That nerve runs down the back of your calf, through the tarsal tunnel and into the sole of your foot. The tarsal tunnel is a narrow space that lies on the inside of your ankle, right next to the bones. When tissues around it become inflamed, they can swell and press on the nerve (nerve compression), causing painful symptoms. And those symptoms can pop up at any point on the posterior tibial nerve’s path, meaning from the inside of your ankle and down into your foot and toes.

While anyone can develop this condition, certain people are at a higher risk for developing tarsal tunnel syndrome. If you have ankle swelling associated with heart or kidney problems, or if your thyroid gland is sluggish, your risk for this kind of compression is elevated. And, since conditions like gout and RA (rheumatoid arthritis) cause the kind of inflammation that can compress your nerve, these conditions also elevate your tarsal tunnel risk.

Any object or injury that limits space in the tarsal tunnel can also lead to nerve compression. For that reason, people whose ankles swell after an injury may experience burning and tingling pain. So, too, individuals with varicose veins may find themselves dealing with tarsal tunnel symptoms. And, finally, the very structure of your foot may elevate your risk. If your feet over-pronate (roll too far inward), or if flat feet have caused your feet to roll outward (supination), your risk will increase, since these positions put added stress on your posterior tibial nerve.

Symptoms of Tarsal Tunnel Syndrome

The most common symptom of tarsal tunnel is pain. But, unlike the pain of an acute injury, the pain associated with this condition typically burns or tingles. You may also experience numbness with tarsal tunnel syndrome. When you experience pain, it may pop up when you stand, walk, or even when you wear a pair of shoes that contributes to the nerve compression. When you first start to notice symptoms your pain will appear and worsen with activity, but wear off when you rest. If left untreated, however, the pain of tarsal tunnel may keep nagging at your feet and ankles even when you’re completely at rest. For that reason, it is extremely important to receive a prompt and accurate tarsal tunnel diagnosis.

Your podiatrist will confirm your tarsal tunnel diagnosis after a thorough in-office exam. During that visit, he or she may perform a physical exam that involves tapping the inside of your ankle to see if you experience tingling (this is known as the Tinel sign.) You may also need a nerve conduction study—a non-invasive procedure that tests how fast electrical impulses move through your nerves—to pinpoint the area of damage and determine its extent. This type of testing can also help determine your best course of treatment,

How Do You Treat Tarsal Tunnel Syndrome?

Initially, we treat this condition with non-invasive options such as:

  • Rest: Getting off your affected foot can help promote healing while preventing further damage. 
    Sometimes, casting can help your body heal from the nerve compression of tarsal tunnel syndrome
  • Ice: Engage in daily icing sessions on the affected area. Limit sessions to 20 minute intervals, separated by a minimum of 40 minutes free of ice.
     
  • Anti-inflammatories: Over the counter drugs such as ibuprofen can help relieve your pain and reduce inflammation.
     
  • Casting: Sometimes, we have to immobilize your affected foot in order to take the pressure off your nerve and the surrounding tissue. 
     
  • Custom orthotics. If your foot anatomy is contributing to your tarsal tunnel symptoms, getting fitted for a custom orthotic device can help alleviate the pressure from your nerve. You may also notice that other nagging foot problems disappear once orthotics become a part of your daily wardrobe.

Unfortunately, some patients don’t respond to these or other less invasive treatment options, such as bracing or steroid injections. If that is the situation you are facing, it may be time to consider surgery. But don’t panic. Tarsal tunnel surgery is fairly routine, and involves your podiatrist making a small incision to the back of your ankle, to gain access and release your ligament from compressing the posterior tibial nerve.

Regardless of which treatment option you and your podiatrist select, it’s important to remember that tarsal tunnel recovery takes some time. But, if you are patient and stick to your prescribed treatment protocol, you are very likely to experience relief. And, the earlier you seek treatment, the sooner that relief can begin!