Tarsal Tunnel Syndrome: Symptoms, Causes, and Treatments


Have you ever experienced a tingling sensation, numbness, or shooting pain in your foot? If so, you might be dealing with a condition called Tarsal Tunnel Syndrome (TTS). This article will guide you through the causes and symptoms to exploring various treatment options.

Short Summary

  • Tarsal Tunnel Syndrome is a condition that occurs when the tibial nerve in the lower leg is compressed within the tarsal tunnel, a narrow passageway on the inner side of the ankle.
  • It can be treated with physical therapy, medications, braces, orthotics and custom footwear. In some cases surgery may be necessary.
  • Preventive measures such as selecting appropriate footwear and performing strengthening exercises are recommended to reduce risk of developing TTS.


Understanding Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome is a condition involving compression or damage to the tibial nerve, causing pain, numbness, and weakness in the foot. It shares similarities with carpal tunnel syndrome, which affects the wrist. The risk of developing tarsal tunnel syndrome can be influenced by various factors.

In this section, we will delve deeper into the anatomy of the tarsal tunnel, the role of the posterior tibial nerve, and the distinction between tarsal tunnel and carpal tunnel syndromes.


What is the tarsal tunnel?

Source – Williams N, Willet J, Clark D, Ketteridge D.

The tarsal tunnel is a structure in the foot that is formed between the underlying bones of the foot and the overlying fibrous tissue.. The tibial nerve, which is responsible for providing sensation to the plantar surface of the foot and innervation of the muscles of the foot and ankle, runs through this narrow tunnel.

When the tibial nerve becomes compressed or entrapped within the tarsal tunnel, it can result in the development of Tarsal Tunnel Syndrome.


Posterior tibial nerve neuralgia

Posterior tibial nerve neuralgia, also known as Tarsal Tunnel Syndrome, is characterized by damage or compression of the tibial nerve in the foot, leading to pain, tingling, or numbness. Potential causes of this condition may include overuse injuries, ankle sprains, flat feet, and other structural issues.


Tarsal tunnel vs. carpal tunnel syndrome

Although Tarsal Tunnel Syndrome affects the tibial nerve in the ankle, it shares some similarities with Carpal Tunnel Syndrome, which impacts the median nerve in the wrist. Both conditions result from nerve compression, leading to symptoms such as:

  • pain
  • numbness
  • tingling
  • burning sensations

The potential causes of these conditions may also overlap, including overuse injuries and structural issues. However, the treatment options for both conditions may vary, ranging from physical therapy and medication to surgery in severe cases.


Identifying the Causes of Tarsal Tunnel Syndrome

Understanding the root causes of Tarsal Tunnel Syndrome is crucial in order to develop an effective treatment plan. Some of the main causes of TTS include:

  • Tibial nerve dysfunction
  • Overuse injuries
  • Ankle sprains
  • Structural issues like flat feet

In the following subsections, we will explore each of these causes in greater detail.


Tibial nerve dysfunction

Tibial nerve dysfunction is a condition where the tibial nerve is compressed or entrapped, resulting in pain, numbness, and tingling in the foot and ankle. This dysfunction can be caused by a variety of factors, such as:

  • Overuse injuries
  • Ankle sprains
  • Flat feet
  • Other structural issues

Proper diagnosis and treatment are essential to address the underlying cause and alleviate the symptoms of tibial nerve dysfunction.


Overuse injuries and ankle sprains

Overuse injuries and ankle sprains are common causes of Tarsal Tunnel Syndrome. These result from repetitive motions that lead to inflammation and pain in the ankle.

Ankle sprains, on the other hand, occur when the ligaments that support the ankle become stretched or torn. Both of these injuries can contribute to the development of TTS by causing inflammation and swelling around the tibial nerve, leading to compression and symptoms.


Flat feet and other structural issues

Structural issues, such as flat feet, can also contribute to the development of Tarsal Tunnel Syndrome. Flat feet, characterized by a flattened arch of the foot, can cause pain and instability, increasing the likelihood of TTS.

Other potential structural issues include ganglion cysts, which can compress the tibial nerve and cause TTS symptoms. Addressing these structural issues can help relieve pressure on the tibial nerve and alleviate TTS symptoms.


Recognizing the Symptoms of Tarsal Tunnel Syndrome

The symptoms of Tarsal Tunnel Syndrome can vary depending on which part of the tibial nerve is affected. In this section, we will explore the different symptoms associated with:

  • Medial plantar nerve involvement
  • Lateral plantar nerve involvement
  • Anterior Tarsal Tunnel Syndrome
  • Posterior Tarsal Tunnel Syndrome

Medial plantar nerve involvement can cause burning, tingling, or numbness in the foot, while issues with the lateral plantar nerves may lead to similar symptoms in different areas of the foot.


Medial plantar nerve symptoms

When the medial plantar nerve is affected in Tarsal Tunnel Syndrome, patients may experience frequent pain, difficulty standing, and sometimes numbness in the foot. These symptoms can be caused by various factors, such as overuse injuries, ankle sprains, and flat feet.

Proper diagnosis and treatment of the underlying cause can help alleviate medial plantar nerve symptoms and improve the patient’s quality of life.


Lateral plantar nerve symptoms

In cases where TTS affects the lateral plantar nerve, symptoms may include:

  • Near-constant pain
  • Difficulty standing
  • Radiating and/or burning pain across the plantar foot
  • A positive Phalen’s test
  • Pain in and around the ankle that extends to the toes
  • Exacerbated pain with walking

Identifying the cause of these symptoms, such as overuse injuries or ankle sprains, can help guide the patient towards appropriate treatment options.


Anterior and posterior tarsal tunnel syndrome

Anterior and posterior Tarsal Tunnel Syndrome are conditions caused by compression of the tibial nerve in the tarsal tunnel, leading to symptoms such as:

  • pain
  • tingling
  • numbness
  • weakness in the foot and ankle

Diagnosis and treatment of the underlying cause of these symptoms are crucial to alleviate discomfort and restore normal function to the affected foot.


Diagnosing Tarsal Tunnel Syndrome

To accurately diagnose Tarsal Tunnel Syndrome, healthcare professionals must conduct a comprehensive physical examination, imaging tests, and nerve conduction studies. These diagnostic tools help determine the root cause of the symptoms, enabling medical professionals to create an effective treatment plan tailored to the patient’s needs.

By using these diagnostic tools, healthcare professionals can accurately diagnose Tarsal Tunnel Syndrome and create an effective treatment plan.


Tarsal tunnel syndrome test and physical evaluation

A physical examination for Tarsal Tunnel Syndrome involves a healthcare professional thoroughly examining the foot and ankle, searching for indications of nerve compression, and evaluating the patient’s reported symptoms.

Tests such as Tarsal tunnel syndrome test ot Tinel’s test, which involves tapping the area around the tarsal tunnel to observe if it elicits pain or tingling, can aid in the diagnosis of TTS.



Imaging tests

Imaging tests, such as X-rays or MRI, may be requested to verify the diagnosis of Tarsal Tunnel Syndrome. These tests can help identify structural issues, such as flat feet or ganglion cysts, that may be contributing to the development of TTS.

Treatment for TTS typically involves a combination of rest, physical therapy, and medications.

Nerve conduction studies

Nerve conduction studies are diagnostic tests that measure the velocity and intensity of electrical signals that are transmitted through a nerve. In the case of Tarsal Tunnel Syndrome, these studies can help detect nerve dysfunction, such as compression or damage, that may be causing the symptoms.

The results of these tests can be crucial in guiding appropriate treatment options for patients with TTS.


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Non-Surgical Treatment Options for Tarsal Tunnel Syndrome

Non-surgical treatments to treat tarsal tunnel syndrome can help alleviate symptoms and improve the patient’s quality of life. These treatments include physical therapy and exercises, nonsteroidal anti-inflammatory drugs (NSAIDs), and the use of braces, orthotics, and custom footwear.

In this section, we will explore each of these treatment options in detail.


Physical therapy and exercises

Physical therapy for Tarsal Tunnel Syndrome offers a variety of advantages, including:

  • Nerve gliding exercises
  • Muscle strengthening
  • Stretching
  • Soft tissue modalities

These techniques can help reduce symptoms, enhance functionality, and relieve pain.

A physical therapist can tailor a treatment plan to the patient’s needs, ensuring optimal results and a faster recovery.



Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen or acetaminophen, can help reduce inflammation and pain associated with Tarsal Tunnel Syndrome. By alleviating swelling in the area, these medications can help relieve pressure on the tibial nerve and improve symptoms.

However, patients should be aware of potential side effects, such as gastrointestinal irritation, and consult their healthcare professional before starting any medication regimen.


Braces, orthotics, and custom footwear

Braces, orthotics, and custom footwear can provide additional support and cushioning for patients with Tarsal Tunnel Syndrome. Braces, for example, can offer support and stability to the ankle, reducing excessive motion in the tarsal tunnel and alleviating pain.

Orthotics and custom footwear can be designed to address specific structural issues, such as flat feet, and help reduce pressure on the tibial nerve.


Surgical Treatment for Tarsal Tunnel Syndrome

In some cases, non-surgical treatments may not be sufficient to alleviate the symptoms of Tarsal Tunnel Syndrome, and surgical intervention may be necessary. A range of surgical procedures is available, each with its own recovery times and success rates.

In this section, we will discuss when surgery is necessary and explore the various surgical options for TTS.


When is surgery necessary?

Surgical intervention for Tarsal Tunnel Syndrome may be indicated when conservative treatment is not successful or when a clearly defined mass, such as a ganglion cyst, is causing the compression. In such cases, surgery can help relieve pressure on the tibial nerve, alleviate symptoms, and prevent potential complications, such as permanent nerve damage.

Surgery is typically performed under local anesthesia and involves releasing the ligament that is compressing.


Types of surgical procedures

Several surgical procedures are available for treating Tarsal Tunnel Syndrome, including:

  • Tarsal tunnel release surgery: involves creating an opening from the rear of the ankle to the arch of the foot and severing the ligament to prevent compression of the tibial nerve
  • Nerve release surgery: involves releasing any entrapped nerves in the tarsal tunnel
  • Tendon transfer surgery: involves transferring a tendon to help relieve pressure on the tibial nerve

The choice of surgical procedure will depend on the patient’s specific circumstances and the underlying cause of TTS.


Recovery and success rates

Recovery times and success rates for surgical treatments of Tarsal Tunnel Syndrome can vary depending on the procedure and the patient’s overall health. In general, the success rate of surgical treatments for TTS is high, with most patients reporting relief from their symptoms.

However, it is crucial for patients to follow their healthcare professional’s post-operative instructions and engage in appropriate rehabilitation to ensure optimal outcomes.


Preventing Tarsal Tunnel Syndrome

Prevention is always better than cure, and this holds true for Tarsal Tunnel Syndrome as well. By taking certain precautions, such as selecting appropriate footwear, performing strengthening exercises, and maintaining a healthy lifestyle, individuals can reduce their risk of developing TTS.

In this section, we will explore each of these preventive measures in more detail.


Footwear selection

Choosing the right footwear is crucial in preventing Tarsal Tunnel Syndrome. Shoes that offer good cushioning and support can help reduce pressure on the tibial nerve and lower the risk of TTS.

In addition, ensuring that your shoes are the correct size can further prevent pressure and strain on the feet.


Strengthening exercises

Performing regular stretching and strengthening exercises for the feet and ankles is another effective preventive measure against Tarsal Tunnel Syndrome. These exercises, such as calf stretches, soleus stretches, and gastrocnemius stretches, can help reduce tension on the tibial nerve and prevent TTS.

By doing these exercises regularly, you can help keep your feet and ankles healthy and reduce inflammation.


Maintaining a healthy lifestyle

A healthy lifestyle plays a vital role in preventing Tarsal Tunnel Syndrome. This includes maintaining a healthy weight, managing stress, and ensuring proper nutrition.

Additionally, incorporating rest between workouts and selecting anti-inflammatory foods can help reduce inflammation and lower the risk of developing TTS.


Living with Tarsal Tunnel Syndrome

For those already diagnosed with Tarsal Tunnel Syndrome, coping with persistent symptoms and seeking ongoing medical care are essential for managing the condition and potentially improving their quality of life.

In this section, we will discuss strategies for coping with TTS symptoms and the importance of continued medical care.


Coping with persistent symptoms

Managing persistent symptoms of Tarsal Tunnel Syndrome can be challenging, but with the right strategies in place, it is possible to maintain a good quality of life. These strategies include:

  • Optimizing rest
  • Avoiding activities that aggravate symptoms
  • Applying ice therapy
  • Taking over-the-counter pain medications
  • Performing nerve gliding and strengthening exercises

Additionally, wearing appropriate footwear and using orthotics or shoe inserts can provide extra support and relief.


Seeking ongoing medical care

Ongoing medical care is crucial for individuals living with Tarsal Tunnel Syndrome. Regular appointments with healthcare professionals can help monitor the condition, address persistent symptoms, and adjust treatment plans as needed. These professionals may include:

  • Orthopedic surgeons
  • Neurologists
  • Physical therapists
  • Podiatrists

Adhering to the doctor’s instructions and maintaining a healthy lifestyle can also improve the effectiveness of treatment and minimize complications.



In conclusion, Tarsal Tunnel Syndrome is a complex condition that requires a thorough understanding of its causes, symptoms, and treatments. By adopting appropriate preventive measures, seeking timely diagnosis and treatment, and committing to ongoing medical care, individuals affected by TTS can effectively manage their condition and lead fulfilling lives. Remember, knowledge is power, and the more you know about TTS, the better equipped you will be to tackle this challenge head-on.


Frequently Asked Questions

How do you fix tarsal tunnel syndrome?

Treatment for tarsal tunnel syndrome typically involves anti-inflammatory medications, steroid injections, braces, splints, or orthotic devices to reduce pressure and swelling on the nerve.

These treatments can help to reduce pain and improve nerve function. However, in some cases, surgery may be necessary to release the pressure on the nerve.


Does it hurt to walk with tarsal tunnel syndrome?

Yes, tarsal tunnel syndrome often causes burning or tingling pain that can be triggered by walking or wearing certain shoes.

These symptoms can be quite debilitating and can interfere with daily activities. Treatment options include rest, physical therapy, and in some cases, surgery.


How do you test for tarsal tunnel syndrome?

To test for tarsal tunnel syndrome, a combination of history taking, physical examination, imaging, and electromyography and nerve conduction studies should be used.

Additionally, the Tarsal Tunnel Compression is also available. Test is performed by pressing firmly over the flexor retinaculum to determine if symptoms such as paresthesia, numbness, or pain develop in the tibial nerve or its distal branches.


What can be mistaken for tarsal tunnel syndrome?

Tarsal Tunnel Syndrome is commonly mistaken for plantar fasciitis, heel spur syndrome, achilles tendonitis and Morton’s neuroma due to similar symptoms.

However, these conditions are not the same and require different treatments. Tarsal Tunnel Syndrome is caused by compression of the tibial nerve, which runs through the tarsal tunnel in the ankle. This compression can cause pain, numbness, and tingling.


What is the primary cause of Tarsal Tunnel Syndrome?

Tarsal Tunnel Syndrome is primarily caused by compression or damage to the tibial nerve in the foot, typically due to overuse injuries, ankle sprains, flat feet, and other structural issues.

These issues can lead to pain, numbness, tingling, and other symptoms in the foot and lower leg. Treatment options include rest, physical therapy, and in some cases, surgery.


Sources and Studies

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  3. Anatomy, Bony Pelvis and Lower Limb, Foot Joints
  4. Metatarsalgia symptoms and causes