Disease Overview
Tarsal tunnel syndrome is a rare disorder caused by damage to the tibial nerve or its branches, usually due to compression as it passes through the tarsal tunnel (entrapment neuropathy). The tarsal tunnel is a narrow passageway bound by bone and soft tissue that lies on the inside of the ankle. The tibial nerve (as well as certain blood vessels and tendons) passes through the tarsal tunnel. However, the term tarsal tunnel syndrome is often broadly applied to any pain along the tibial nerve, which can result from a multitude of causes. Individuals with tarsal tunnel syndrome may experience pain, burning, or a tingling sensation along the tibial nerve.
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Signs & Symptoms
The specific symptoms of tarsal tunnel syndrome can vary from one person to another. In some cases, symptoms can develop suddenly, and in others gradually. Some affected individuals may experience a sharp, shooting pain along the tibial nerve. This nerve branches off from the sciatic nerve and runs down the lower leg to the ankle and then the foot. Pain can be severe enough to cause a person to limp. Affected individuals may describe a radiating pain that cannot be localized to one spot. In addition to or instead of pain, affected individuals may experience numbness of the affected area or a burning or tingling sensation (paresthesia), which is often described as similar to “pins and needles”.
In some individuals, symptoms may affect one spot such as the inside of the ankle. In other individuals, symptoms can affect the ankle, heel and foot. For example, pain may radiate from the ankle down to the heel or even the foot, depending on which section of the nerve is affected. Less frequently, pain may radiate up from the ankle to the calf.
The symptoms of tarsal tunnel syndrome are often worsened by activity such as prolonged standing or walking. Consequently, pain may worsen throughout an active day. Symptoms are usually relieved by rest. However, as the disorder progresses, some affected individuals have reported pain that occurs during rest or at night when attempting to sleep.
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Causes
Tarsal tunnel syndrome can be caused by any condition that causes compression of the tibial nerve or its branches as it passes through the tarsal tunnel. A wide variety of conditions can cause tarsal tunnel syndrome including space-occupying lesions or masses, which may increase pressure in the tunnel. Such lesions include tumors consisting mainly of fat tissue (lipomas), tumors consisting of nerve fibers and ganglion cells (gangliomas) and tumors of the nerve sheath (schwannomas).
Additional conditions that can cause tarsal tunnel syndrome include a benign bony growth in the tarsal tunnel (exostosis), enlarged (varicose) veins and inflammation of the synovial membrane (proliferative synovitis). Certain injuries or trauma such as an ankle sprain, fracture or valgus foot deformity may cause inflammation and swelling that can lead to tarsal tunnel syndrome. In addition, certain disorders such as diabetes and arthritis can also cause inflammation and swelling that can lead to tarsal tunnel syndrome.
Individuals who have severely flat feet (pes planus) are at a greater risk of developing tarsal tunnel syndrome than the general population because the flattened “fallen” arches can stretch the tibial nerve.
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Affected populations
The incidence and prevalence of tarsal tunnel syndrome is unknown. The disorder is believed to affect males and females in equal numbers.
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Disorders with Similar Symptoms
Symptoms of the following disorders can be similar to those of tarsal tunnel syndrome. Comparisons may be useful for a differential diagnosis.
Plantar fasciitis is a common condition characterized by inflammation of the thick band of tissue which runs along the bottom of the foot (plantar fascia). The plantar fascia supports the arch of the foot and acts as a shock absorber. Plantar fasciitis is a common cause of heel pain and is often described as a sharp pain in the heel. Pain associated with plantar fasciitis tends to develop gradually and tends to be worse in the morning and may improve throughout the day and with stretching exercises. Additionally, the pain is unlike the shooting and tingling pain associated with tarsal tunnel syndrome.
A wide variety of conditions can cause pain in the foot or ankle including diabetes (diabetic neuropathy), posterior tibial tendinosis, stress fractures, certain rare disorders such as reflex sympathetic dystrophy and certain disorders that affect the nerves outside of the central nervous system (peripheral neuropathy).
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Diagnosis
A diagnosis of tarsal tunnel syndrome is made based upon identification of characteristic symptoms, a detailed patient history, a thorough clinical evaluation and a variety of specialized tests. A specific finding that can detect an irritated nerve is Tinel’s sign. During a Tinel’s sign test, a doctor will tap or apply pressure to the tibial nerve. If this causes a tingling or a “pins and needles” sensation in the foot or toes, it is considered positive and is indicative of tarsal tunnel syndrome.
Additional tests that may be performed include electromyography and magnetic resonance imaging (MRI). Electromyography is a test that can determine the health of muscles and nerves and can detect nerve dysfunction. An MRI uses a magnetic field and radio waves to produce cross-sectional images particular organs and bodily tissues and may be used if a space-occupying is the suspected cause of tarsal tunnel syndrome or to detect if the nerve is irritated.
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Standard Therapies
Treatment
The treatment of tarsal tunnel syndrome is directed toward the specific symptoms that are apparent in each individual. Physicians may recommend conservative treatment, which can include rest, contrast baths, nonsteroidal anti-inflammatory drugs (NSAIDs), and nonrigid orthotics. Orthotics refers to devices such as splints or braces that are used to protect or correct the position of the foot. In some cases, changing to looser or larger footwear to reduce tightness can relieve pain associated with tarsal tunnel syndrome.
Some individuals may benefit from a local injection of certain medications (anesthetics) to reduce pain or corticosteroids to reduce inflammation. This may also prove to be diagnostic, as relief brought on by an injection of an anesthetic around the affected nerve confirms the diagnosis. Immobilization such as through the use of a cast can also be beneficial in some cases. Physical therapy may also be recommended.
Individuals with tarsal tunnel syndrome due to flat feet may be treated with orthotics designed to provide support or restore the natural arch of the foot.
Surgery is recommended for individuals with severe symptoms who do not respond to conservative treatment. The purpose of the surgery is to decompress the nerve from within the tarsal tunnel and/or removal of any space-occupying lesion.
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Clinical Trials and Studies
Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.
For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:
Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: [emailprotected]
Some current clinical trials also are posted on the following page on the NORD website:
https://rarediseases.org/living-with-a-rare-disease/find-clinical-trials/
For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com
For information about clinical trials conducted in Europe, contact:
https://www.clinicaltrialsregister.eu/
Contacts for additional information about tarsal tunnel syndrome:
John G. Kennedy, MD, MCh, MMSc, FFSEM, FRCS (Orth)
Attending Orthopaedic Surgeon
[emailprotected]
Niall A. Smyth, MD
Orthopaedic Resident
[emailprotected]
Hospital for Special Surgery
535 East 72nd Street
New York, NY 10021
Website: sportsmedicinenewyork.com
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References
TEXTBOOKS
Cook RA, O’Malley MJ. Tarsal Tunnel Syndrome. NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:592.
JOURNAL ARTICLES
Low HL, Stephenson G. These boots weren’t made for walking: tarsal tunnel syndrome. CMAJ. 2007;176:1415-1416.
Miranpuri S, Snook E, Vang D, Yong RM, Chagares WE. Neurilemoma of the posterior tibial nerve and tarsal tunnel syndrome. J Am Podiatr Med Assoc. 2007;97:148-150.
Gondring WH, Shields B, Wenger S. An outcomes analysis of surgical treatment of tarsal tunnel syndrome. Foot Ankle Int. 2003.24:545-550.
Nagaoka M, Satou K. Tarsal tunnel syndrome caused by ganglia. J Bone Joint Surg Br. 1999;81:607-610
INTERNET
Persich G, Touliopoulos S. Tarsal Tunnel Syndrome. Medscape. Updated: Jun 21, 2018. Available at: http://emedicine.medscape.com/article/1236852-overview Accessed Sept. 12, 2018.
Wheeless CR. Tarsal Tunnel Syndrome. Wheeless’ Textbook of Orthopaedics. May 23, 2012. Available at: http://www.wheelessonline.com/ortho/tarsal_tunnel_syndrome Accessed Sept. 12, 2018.
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FAQs
What is the most common cause of tarsal tunnel syndrome? ›
Tarsal tunnel syndrome results from the compression of the posterior tibial nerve or one of its two branches, the lateral or medial plantar nerve, within the tarsal tunnel. Up to 43% of patients have a history of trauma including events such as ankle sprains. Abnormal biomechanics can contribute to disease progression.
What is the best treatment for tarsal tunnel syndrome? ›Rest: Staying off of your foot for a few days or weeks can promote healing and prevent further injury. Ice: Use ice packs for up to 20 minutes, a few times a day. Icing your foot can reduce swelling and pain. Compression and elevation: You may wear a supportive elastic bandage or brace around your ankle.
What aggravates tarsal tunnel syndrome? ›They are often brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising or beginning a new exercise program. It is important to seek early treatment if any of the symptoms of tarsal tunnel syndrome occur.
What can be mistaken for tarsal tunnel syndrome? ›However, there is another “tunnel syndrome” involving the foot called Tarsal Tunnel Syndrome that results in similar symptoms, and is often not detected or is misdiagnosed as plantar fasciitis, heel spur syndrome, or achilles tendonitis.
Is it OK to walk with tarsal tunnel syndrome? ›Tarsal tunnel syndrome can make it hard to walk or engage in other physical activities. These exercises focus on gentle movements to reduce irritation and building strength and flexibility in the ankle. Calf stretches can help reduce tightness in the muscles around the ankle, relieving stress and swelling.
Can you get rid of tarsal tunnel? ›Tarsal tunnel syndrome can be managed or cured with a wide variety of treatment options, but regardless of what the underlying condition is, it's essential to get early treatment to prevent permanent nerve damage.
What kind of doctor is best for tarsal tunnel syndrome? ›See a podiatrist.
method, it greatly helps to see a podiatrist, who specializes in the diagnosis and treatment of foot and ankle conditions—including tarsal tunnel syndrome. Your podiatrist will perform a thorough evaluation to confirm a diagnosis then proceed with creating an effective treatment plan for you.
Tarsal Tunnel Compression Test (Durkan's)
Tarsal Tunnel Compression Test: Examiner presses firmly over the flexor retinaculum for up to 30 seconds or until symptoms develop. Test is considered positive if paresthesia, numbness, or pain develop in tibial nerve or distal branches in the foot.
Tarsal tunnel syndrome can take anywhere from 2 weeks to 6 months. Once you begin therapy you will start to feel better. The time frame for recovery depends on the extent and cause of the nerve compression. Rehabilitation is important to restore ankle strength and balance and to prevent a recurrence.
Do compression socks help tarsal tunnel syndrome? ›Supporting devices help in decompressing the nerve and give better posture for the foot, thus relieving pain. Some of them are compression socks, specially designed shoes, and soles that can potentially reduce the pressure on the tibial nerve and are recommended in the treatment of tarsal tunnel syndrome.
Does tarsal tunnel show up on MRI? ›
MR imaging with its excellent soft tissue contrast can demonstrate clearly the anatomy of the tarsal tunnel and its contents. MRI is able to demonstrate a space-occupying lesion and its relationship to the posterior tibial nerve and its branches.
Will an MRI show a tarsal tunnel? ›MR imaging can accurately depict the contents of the tarsal tunnel and the courses of the terminal branches of the posterior tibial nerve.
Does a brace help tarsal tunnel syndrome? ›People with tarsal tunnel syndrome who have severe symptoms and nerve damage or flat feet may benefit from wearing a brace such as the McDavid Ultralight Ankle Brace 195, which offers incredible ankle protection. A brace will reduce the amount of pressure on the foot and help the ankle heel faster.
How do you release a tarsal tunnel nerve? ›In tarsal tunnel release, the surgeon creates an opening behind the ankle that extends down to the arch of the foot. The surgeon carefully divides the ligament so it is not pressing against the tibial nerve. Specializing In: Neuromuscular Disease.
How long can tarsal tunnel syndrome last? ›Tarsal tunnel syndrome can take anywhere from 2 weeks to 6 months. Once you begin therapy you will start to feel better. The time frame for recovery depends on the extent and cause of the nerve compression. Rehabilitation is important to restore ankle strength and balance and to prevent a recurrence.
Is heat or ice better for tarsal tunnel syndrome? ›In severe cases an orthotic may make it hurt worse because it puts too much pressure on the pinched nerve. You can elevate your foot and apply ice at the same time if you have any swelling. Putting a heating pad on the inside of your ankle may also help increase circulation to the pinched nerve and relieve pain.
Will an MRI show tarsal tunnel syndrome? ›MR imaging with its excellent soft tissue contrast can demonstrate clearly the anatomy of the tarsal tunnel and its contents. MRI is able to demonstrate a space-occupying lesion and its relationship to the posterior tibial nerve and its branches.