Tarsal Tunnel Syndrome

What Is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is a medical condition associated with numbness, pain, and a tingling or burning sensation in the ankles and feet. It results from compression of the posterior tibial nerve, which provides feeling and muscle mobility to the forward parts of the foot. The tarsal tunnel is the posterior tibial nerve’s pathway through the ankle into the foot, named for the small and irregularly shaped tarsal bones that comprise the hindfoot. It also contains arteries, veins, and tendons, protected by a tough sheath of ligament. The exact incidence of tarsal tunnel syndrome in the U.S. is unknown, though women and men appear similarly affected by it.  

If left untreated, tarsal tunnel syndrome can, in extreme cases, lead to nerve damage and permanent disability. Let the orthopedic specialists and other medical providers at Baptist Health assist you if you or a family member is dealing with this condition.

What Are the Symptoms of Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is characterized by a number of symptoms. These may come on suddenly or gradually, worsening over time.

Symptoms include:

  • Pain, sometimes stabbing and severe
  • A tingling or burning sensation
  • A feeling akin to electrical shock
  • Foot and ankle numbness
  • A loss of sensation in the foot or toes

Physical activity tends to aggravate the pain and discomfort. In more advanced cases, symptoms will manifest even when a person is at rest or while sitting or lying down. 


What Causes Tarsal Tunnel Syndrome? 

Any repetitive action or injury that irritates or places pressure on the posterior tibial nerve can lead to tarsal tunnel syndrome. This includes both dramatic single causes, such as ankle fractures, and more subtle multiple causes, such as the use of the ankles and feet in physically demanding tasks combined with other medical or anatomical factors. 


Risk factors that increase the likelihood of tarsal tunnel syndrome include:

  • Job requirements that call for long periods of being on one’s feet
  • Foot or ankle injuries, including fractures and dislocations
  • Flat feet or foot deformities
  • Bone spurs, cysts, lesions, tumors, or varicose veins that press on the nerve
  • Being overweight
  • Nerve disorders
  • Other medical disorders, such as diabetes, which cause nerve damage
  • Rheumatoid arthritis and other inflammatory conditions
  • Bodily fluid retention, which can increase pressure in the ankle and feet

Poorly fitting shoes can also be a source of pressure or rubbing on the nerve.


How Is Tarsal Tunnel Syndrome Diagnosed?

Diagnosing tarsal tunnel syndrome is a multi-step process. Your physician will start by giving you a physical exam, asking questions about your symptoms, and recording your medical history. He or she may then test for tarsal tunnel syndrome using one or more of these methods:

  • Tinel’s sign: Tinel’s sign involves testing the foot and toes for physical sensation by tapping the foot where the tarsal tunnel and posterior tibial nerve are located.  
  • Electromyography (EMG) and nerve-conduction study: Electromyography is a medical test of electrical activity in the muscles and nerves. EMGs can be used to determine the effectiveness of the posterior tibial nerve in delivering the brain’s electrical impulses to the muscles and nerves of the foot. 
  • X-rays or magnetic resonance imaging (MRI) exams: X-rays or MRIs can provide insight on the presence of bone spurs or other intrusive masses in the ankle or foot, which can be indicators of tarsal tunnel syndrome. 

How Is Tarsal Tunnel Syndrome Treated?

There are both surgical and non-surgical treatments for tarsal tunnel syndrome. Non-surgical treatments are typically utilized with less serious cases, while surgery is limited to those situations where tarsal tunnel syndrome impedes the operations of daily living.


Non-surgical Treatments

Non-surgical treatments include:

  • Resting and immobilizing the ankle and foot 
  • Applying ice
  • Over-the-counter medications, such as ibuprofen
  • Corticosteroid injections
  • Braces and other orthotic devices
  • Supportive shoes
  • Physical therapy

Surgical Treatments

Surgery is the primary alternative when non-invasive treatments fail to provide relief. The goal of surgery is to expand the tarsal tunnel, thereby relieving pressure on the posterior tibial nerve, by cutting the flexor retinaculum ligament. The latter is one of the tarsal tunnel’s structural elements, but also serves to reinforce any pressure being applied to the posterior tibial nerve when the tunnel is otherwise constricted. Tarsal tunnel surgery is typically performed on an outpatient basis, with a full recovery time of up to four to six weeks. 


The variety of treatment options for tarsal tunnel syndrome often bring relief. One key is diagnosing the condition early, before nerve damage accumulates and when treatments are most effective. 


Can Tarsal Tunnel Syndrome be Prevented?

It is sometimes possible to prevent tarsal tunnel syndrome, if potential causes are identified and dealt with proactively. For example, wearing work-appropriate footwear or an orthotic brace can support the foot and ankle without placing undue stress on the tarsal tunnel and the posterior tibial nerve. 


Learn More About Tarsal Tunnel Syndrome Treatment from Baptist Health

Tarsal tunnel syndrome can turn the simplest tasks – even just walking around – into a painful ordeal. If you’re experiencing the symptoms of tarsal tunnel syndrome, contact the Baptist Health Orthopedic Team to schedule an appointment. 

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