What is Tarsal Tunnel Syndrome?

It is an irritation or compression of the tibial nerve inside the ankle, in the tarsal tunnel.

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Specifically, what is the tarsal tunnel?

It is a tunnel inside the ankle through which several tendons and the tibial nerve pass. The tunnel is formed by the bones inside the ankle and ligaments.

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"If the space in the tarsal tunnel is too small for the tibial nerve to move properly, irritation of this nerve can develop, and this is called tarsal tunnel syndrome." In short, it's like carpal tunnel syndrome, but in the ankle.

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What is a nerve?

A nerve is a body structure responsible for transmitting information to our nervous system. Information travels through the nerve in the form of electricity. For example, nerves allow us to feel our skin when we touch a part of our body. They also allow us to send electricity to our muscles to contract them and move our limbs.

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What is the tibial nerve?

The tibial nerve is one of the main nerves in the foot. It starts at the knee, goes down the calf, then passes through the tarsal tunnel and continues under the foot to the toes. The tibial nerve is responsible for the sensitivity of 90% of the sole of the foot. It is also the nerve that provides the electrical signal to the calf muscles and the muscles that flex the toes.

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What are the causes of tarsal tunnel syndrome?

"The syndrome is caused by a mixed phenomenon of compression and stretching of the tibial nerve. This leads to a problem with blood circulation in the nerve."

The precise cause of the syndrome varies from person to person.

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Here are several factors that may be associated with tarsal tunnel syndrome:

• Overload on the ankle or foot during weight-bearing activities (walking, running, jumping)
• Poor muscular control of the ankle or arch of the foot
• Direct trauma to the inside of the ankle
• Having had a medial ankle sprain (ligaments on the inside of the ankle)

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Up to 43% of people with tarsal tunnel syndrome have had a previous ankle injury, such as a sprain.

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What are the symptoms of tarsal tunnel syndrome?

The main symptoms are:

• Pain on the inside of the ankle, under the malleolus (the bony bump)
• The pain may radiate towards the arch of the foot or even across the entire sole.
• You may feel burning, numbness, or tingling in the foot or toes.

• Feeling of loss of strength in the foot
• Change in sensation in the foot or toes
• The pain is generally increased by prolonged weight-bearing activities (walking, standing, running, jumping).
• The pain is often worse when getting up in the morning or after periods of immobilization.

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How is tarsal tunnel syndrome diagnosed?

Diagnosis is made through a review of your symptom history and a clinical examination.

Sometimes, an EMG (electromyographic examination) may be necessary to assess nerve function. However, the vast majority of tarsal tunnel syndrome cases can be treated without this test.

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When should I see a physiotherapist for tarsal tunnel syndrome?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

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You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

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What are the physiotherapy treatments for tarsal tunnel syndrome?

Your physiotherapist will perform a thorough assessment to determine the cause of the nerve irritation. They will assess the following elements:

• Your joint mobility
• The gliding of your nerves
• The quality of your movements
• Your strength and stability

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Based on the assessment results, your physiotherapist will:

• Mobilize your joints, muscles, and nerves to reduce pain and improve movement.
• Provide you with specific exercises to retrain the strength and stability of your foot.
• Give you specific exercises to learn how to properly control your movements.
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your posture and movements.

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What can I do at home for Tarsal Tunnel Syndrome?

Temporarily reduce the amount of time you spend doing activities that cause too much pain, and then gradually resume them.

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Here are some tips that may help:

• Engage in activities that reduce stress on the area, such as swimming or cycling.
• Take frequent but short breaks in a seated position if the pain increases when you walk or stand for long periods.

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If you don't see any improvement after 10 days, you should consult a physiotherapist.

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If you are a runner, please refer to the blog article on running (link to come) for concrete tips for running.

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To learn more...

You can listen to the podcast PARLE-MOI DE SANTÉ created by one of our physiotherapists, Alexis Gougeon.

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Episode #1 discusses the prevention and treatment of running injuries.

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Find the episode on YouTube:

Click below to listen to episodes on podcast platforms:

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Sources

• Cimino WR. Tarsal tunnel syndrome: review of the literature. Foot & Ankle. 1990 Aug;11(1):47-52.
• Kiel J, Kaiser K. Tarsal Tunnel Syndrome. [Updated 2020 Aug 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.