Tarsal Tunnel Syndrome

Do you feel burning under your foot? Numbness that spreads up to your ankle? That tingling sensation that appears when you walk for too long? These symptoms may indicate tarsal tunnel syndrome.

As physical therapists, we regularly evaluate and treat this condition. Tarsal tunnel syndrome is a compression of the tibial nerve inside the ankle. It causes pain, burning, and numbness under the foot. Physical therapy effectively treats this condition without surgery in most cases.

^- Conservative treatment works: 60 to 90% of cases respond well to physical therapy.¹ - Trauma is a risk factor: 43% of people with this condition have had a previous ankle injury.2 - Surgery is rarely necessary: It is reserved for cases that do not respond to treatment. - Early intervention is important: The earlier treatment begins, the better the results.

This guide explains this condition and how to treat it effectively. For an overview of ankle pain, see our comprehensive guide.

What is tarsal tunnel syndrome?

Tarsal tunnel syndrome is an irritation or compression of the tibial nerve in the tarsal tunnel, located inside the ankle. It is the equivalent of carpal tunnel syndrome, but in the ankle instead of the wrist.

You may be familiar with carpal tunnel syndrome in the wrist. Tarsal tunnel syndrome works in a similar way, but in the ankle.

The tarsal tunnel is a passageway located under the bony bump inside your ankle (the medial malleolus). This tunnel is formed by the ankle bones and a ligament that acts as a roof.

When the space in this tunnel becomes too narrow, the tibial nerve is compressed. This compression causes the nerve symptoms you are experiencing.

Now let's look at the role of this important nerve.

What is the tibial nerve and what is its role?

The tibial nerve is one of the main nerves in the foot. It starts at the knee, descends into the calf, and passes through the tarsal tunnel. It is responsible for 90% of the sensitivity in the sole of the foot and innervates the muscles that bend the toes.³

Think of nerves as electrical cables that transmit signals. The tibial nerve carries two types of signals:

- Sensitivity in almost the entire sole of the foot - Sensations of touch, temperature, and pressure

- Commands to the calf muscles - Commands to the muscles that bend your toes

When this nerve is compressed, electrical signals do not pass through properly. This causes abnormal sensations such as burning, numbness, and tingling.

Now let's look at what can cause irritation of this nerve.

What are the causes of tarsal tunnel syndrome?

The syndrome is caused by a combination of compression and stretching of the tibial nerve. This reduces blood flow to the nerve. Up to 43% of those affected have a history of ankle trauma.²

The exact cause varies from person to person. Several factors may contribute:

How can you tell if you have this syndrome? Here are the symptoms to look out for.

What are the symptoms of tarsal tunnel syndrome?

The main symptoms are pain inside the ankle, below the malleolus. The pain may radiate to the arch of the foot or the entire underside of the foot. Burning, numbness, or tingling sensations are often felt in the foot and toes.

Do not confuse this with plantar fasciitis, which causes pain in the heel rather than inside the ankle.

If these symptoms sound familiar, let's take a look at how the diagnosis is made.

How is tarsal tunnel syndrome diagnosed?

The diagnosis is made based onthe history of symptoms and clinical examination. An EMG may be useful but is not always necessary. The vast majority of cases can be treated effectively without this test.³

Your healthcare professional will:

1. Ask you questions about your symptoms: location, onset, what aggravates or relieves them 2. Examine your ankle and foot: mobility, strength, sensitivity 3. Perform specific tests: such as Tinel's test (tapping on the tunnel to see if it reproduces your symptoms)

EMG measures electrical activity in your nerves and muscles. It can confirm nerve damage, but: - It is not always necessary to begin treatment - Results may be falsely negative in the early stages - Most tarsal tunnel syndromes can be treated without this test

Now that you know what it is, let's see when to seek medical advice.

When should you see a physical therapist?

Consult if you have pain, burning, or numbness in your ankle or foot. You do not need to see a doctor first. If your condition requires medical advice, your physical therapist will refer you.

- Persistent pain inside the ankle - Burning or numbness under the foot - Symptoms that increase with activity - Tingling in the toes

The earlier treatment begins, the better the results. Do not wait until symptoms become chronic.

Let's see what physical therapy can do for you.

What are the physiotherapy treatments?

Your physical therapist will evaluate your joint mobility, nerve gliding, movement quality, and strength. Treatment includes mobilization, stabilization exercises, and rehabilitation to optimize healing.

- Mobility of your ankle and foot - Testing the slippage of yournerves - Assessment of the quality of yourmovements - Measurement of your strength and stability

Treatment is tailored to your needs. Every person is different and the causes can vary.

Between sessions, here is what you can do at home.

What to do at home?

Temporarily reduce activities that cause too much pain and gradually reintroduce them. Focus on low-impact activities such as swimming or cycling. Take frequent breaks if the pain increases when standing for long periods of time.

Finally, let's talk about healing time.

How long does the healing process take?

The healing time varies depending on the severity and duration of symptoms. With physical therapy treatment, most people see significant improvement within 6 to 12 weeks. Early treatment yields better results.

- How long you have hadthe symptoms - The severity of the nerve compression - Your ability to follow recommendations - The underlying cause of the problem

- Conservative treatment (physical therapy) works in 60 to 90% of^cases. - Surgery is rarely necessary. - Most people return to their normal activities.

Key points to remember

Tarsal tunnel syndrome is a compression of the tibial nerve at the ankle that causes pain, burning, and numbness. This condition can be effectively treated with physical therapy in most cases.

- Symptoms are caused by nerve compression, not wear and tear - Conservative treatment works in 60 to 90% of cases - Early treatment yields better results - Surgery is rarely necessary

If you have symptoms of tarsal tunnel syndrome, don't wait. Consult a physical therapist for a complete evaluation and personalized treatment plan. You don't need a doctor's referral.

References

1. Ahmad M, Tsang K, Mackenney PJ, Adedapo AO. Tarsal tunnel syndrome: A literature review. Foot Ankle Surg. 2012;18(3):149-152. 2. Cimino WR. Tarsal tunnel syndrome: review of the literature. Foot Ankle. 1990;11(1):47-52. 3. Kiel J, Kaiser K. Tarsal Tunnel Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. 4. Lau JT, Daniels TR. Tarsal tunnel syndrome: a review of the literature. Foot Ankle Int. 1999;20(3):201-209. 5. McSweeney SC, Cichero M. Tarsal tunnel syndrome-A narrative literature review. Foot (Edinb). 2015;25(4):244-250.