Tarsal Tunnel Syndrome
What is Tarsal Tunnel Syndrome?
Tarsal Tunnel Syndrome is a condition of the foot involving compression of the tibial nerve. The tibial nerve is an extension of the sciatic nerve which runs down the back of the thigh. The tibial part extends across the inside of the shin and then splits in the foot to supply sensation and movement to the muscles along the bottom and inner aspect of the foot.
Tarsal Tunnel Syndrome entails compression of the end part of the tibial nerve as it travels through the tarsal tunnel which is located between the Achilles tendon and a bony protuberance along the inner aspect of the ankle. In this region, the tibial nerve also passes underneath a dense piece of connective tissue (or retinaculum), which can be a source of compression when it becomes too tight.
What Causes Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome can occur as a result of a trauma (i.e. fall or impact). Overuse of the muscles and tendons that supply the muscles which bend the toes can also be a precipitating factor. Hence, tarsal tunnel syndrome can acutely result following a marathon or endurance race (Antoniadis 2008). Complications post-surgery or following an ankle sprain or other lower limb injury which produces swelling around the ankle can cause compression of the tibial nerve (Antoniadis 2008). People with diabetes and rheumatoid arthritis are also at increased risk of developing tarsal tunnel syndrome.
Posterior Tarsal Tunnel Syndrome: Diagnosis and Treatment. Antoniadis, G., Schedglmann, K. (2008). Deutsches Arzteblatt International. 105(45): 776-81.
What are the Symptoms of Tarsal Tunnel Syndrome?
The primary symptom someone with tarsal tunnel syndrome experiences is pain. In particular, burning pain along the inner aspect of the ankle and/or into the bottom of the foot. The following symptoms may also occur:
How is Tarsal Tunnel Syndrome Diagnosed?
Your physiotherapist or doctor can provisionally diagnose tarsal tunnel syndrome. They will conduct a variety of physical tests to support the diagnosis if it is suspected through your verbal injury history. In some cases, a nerve conduction study may be required to confirm the diagnosis.
Treatment for Tarsal Tunnel Syndrome?
Many patients with tarsal tunnel syndrome start to feel better within a couple of weeks of treatment. The time frame of your recovery will depend on a variety of factors such as age, previous activity level, treatment compliance and the degree/length of your injury.
Your physiotherapy treatment will aim to:
If you have any questions at any stage of your rehabilitation, please call your physiotherapist.
How to Prevent Tarsal Tunnel Syndrome?
There are a few things you can do to reduce your risk of developing tarsal tunnel syndrome. These include
Alternative Treatments for Tarsal Tunnel Syndrome
Injections: Injections of a local anaesthetic and corticosteroids into the tarsal tunnel region can sometimes be beneficial in some cases.
Surgery: In cases of severe pain, surgery can be quite effective. The procedure involves decompressing the affected parts of the tibial nerve and potentially its branches in the foot. The post-surgical routine involves elevating the operated leg and walking with crutches for two weeks (Antoniadis 2008).
For further information please contact your physiotherapist or doctor.
Tarsal Tunnel Treatment Options
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