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The Anatomy of Tarsal Tunnel Syndrome

The tarsal tunnel is a narrow space inside the ankle next to the bones. This tunnel is covered by a thick ligament called the flexor retinaculum, which protects and maintains the structures contained within the tunnel, including blood vessels, tendons, and the tibial nerve. Tarsal tunnel syndrome occurs when there is compression on the tibial nerve, leading to various symptoms that can affect mobility and daily activities.

Causes and Risk Factors

Tarsal Tunnel Syndrome can result from various factors that compress the tibial nerve. Common causes and risk factors include:

  • Overuse: Repetitive activities that put stress on the ankle, such as running or prolonged standing, can lead to nerve compression.
  • Injury: Ankle injuries, including sprains and fractures, can cause swelling and pressure on the tibial nerve.
  • Structural Abnormalities: Flat feet or other structural problems can increase the risk of developing tarsal tunnel syndrome due to abnormal stress on the tibial nerve.
  • Medical Conditions: Conditions such as arthritis, diabetes, or varicose veins can cause swelling or inflammation that compresses the nerve.
  • Masses or Growths: Ganglion cysts, bone spurs, or lipomas within the tarsal tunnel can put pressure on the tibial nerve.


The symptoms of tarsal tunnel syndrome can vary in intensity and may include:

  • Sharp, shooting, or burning pain in the foot, ankle, and sometimes extending into the toes
  • A sensation of pins and needles or loss of feeling in the affected area
  • Swelling around the ankle and foot
  • Weakness in the foot muscles, leading to difficulty walking or maintaining

Diagnostic Process

Diagnosing tarsal tunnel syndrome involves a thorough medical evaluation, including:

    • Medical History: Discussing your symptoms, activities, and any previous injuries with your healthcare provider.
    • Physical Examination: Assessing the foot and ankle for signs of tenderness, swelling, and nerve compression. The Tinel’s sign test, where tapping over the tibial nerve causes tingling, may be used.
    • Imaging Tests: X-rays, MRI, or ultrasound may be used to identify any structural abnormalities or masses that could be causing nerve compression.

Nerve Conduction Studies: Electromyography (EMG) or nerve conduction velocity (NCV) tests to assess the function of the tibial nerve and confirm the diagnosis.

Treatment Options

Conservative Care

For many individuals, non-surgical treatments can effectively manage the symptoms of tarsal tunnel syndrome:

  1. Rest and Activity Modification: Reducing activities that aggravate symptoms and allowing the foot to rest.
  2. Ice Therapy: Applying ice packs to reduce swelling and alleviate pain.
  3. Medications: Over-the-counter pain relievers and anti-inflammatory medications to manage pain and inflammation.
  4. Orthotics: Custom-made shoe inserts to correct foot mechanics and reduce pressure on the tibial nerve.
  5. Physical Therapy: Exercises to strengthen the foot and ankle muscles, improve flexibility, and reduce nerve compression.

Surgical Treatment

When conservative treatments do not provide sufficient relief, surgery may be necessary to relieve pressure on the tibial nerve. The procedure, known as tarsal tunnel release, involves making an incision along the ankle and foot to release the flexor retinaculum and any other structures compressing the nerve. This can provide significant relief and improve function.

Recovery and Rehabilitation

Recovery from tarsal tunnel syndrome treatment varies depending on the severity of the condition and the treatment method used. For conservative care, adhering to recommended activities, wearing orthotics, and performing physical therapy exercises are crucial for recovery. For surgical treatment, following post-operative care instructions, such as keeping the surgical site clean, managing pain, and gradually resuming activities under the guidance of a healthcare provider, is essential for optimal recovery.

Living with Tarsal Tunnel Syndrome

Managing tarsal tunnel syndrome involves a combination of lifestyle adjustments, appropriate footwear, and medical care. Regular follow-ups with your healthcare provider, adherence to treatment plans, and making healthy lifestyle choices can help maintain foot and ankle health and reduce symptoms.

If you experience symptoms of tarsal tunnel syndrome, contact Excel Health for a comprehensive evaluation and personalized treatment plan. Our dedicated team is here to support you every step of the way, ensuring you receive the highest quality care.

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