The tarsal tunnel is a narrow space found on the inside of the ankle and is formed by the ankle bones and ligaments’ band which stretches across the foot. Most of the nerves, tendons and blood vessels which provide flexibility and movement to the feet pass through the tarsal tunnel. One of the structures within the tarsal tunnel is the posterior tibial nerve and it is the focus of the tarsal tunnel syndrome.

Tarsal tunnel syndrome (TTS) is a compression on the posterior tibial nerve which produces symptoms along the nerve’s path that is running from the inside of the ankle into the foot. Tarsal tunnel syndrome is similar to carpel tunnel syndrome, which occurs in the wrist as both conditions arise from the compression of a nerve in a confined space.

Causes of Tarsal Tunnel Syndrome

Tarsal tunnel syndrome can be caused by anything that compresses or strains the tibial nerve such as:

• Fallen arches or flat feet
• Swelling that is caused by ankle sprain
• Disorders such as diabetes or arthritis which cause swelling and nerve compression
• An abnormal or enlarged structure that occupies space in the tunnel such as a ganglion cyst, varicose vein, swollen tendon or bone spur.

Symptoms of Tarsal Tunnel Syndrome

One or more of the following symptoms can be experienced by an individual with tarsal tunnel syndrome:

• Numbness on the area
• Shooting pain
• Burning or a tingling sensation

The symptoms can be felt at the bottom of the foot and/or on the inside of the ankle. The symptoms may occur in just one particular spot or in various areas within the foot such as the heel, toes, arch and calf.

The symptoms of the tarsal tunnel syndrome can appear suddenly, or they can be aggravated by the overuse of the foot such as prolonged walking, standing or exercising. If left untreated, the condition can result in permanent nerve damage.

Diagnosis of Tarsal Tunnel Syndrome

Tarsal tunnel syndrome can easily be confused with other conditions, that is why a proper diagnosis is required to be done by an expert nerve specialist or neurologist. The severity of the condition and underlying cause has to be determined first before the appropriate treatment is recommended.

Diagnosing tarsal tunnel syndrome involves:

• Checking the medical history of the patient
• Comprehensive clinical or physical exam
• Electrical testing (nerve conduction study or EMG)
• Imaging (CT scan, X-rays or MRI)

Treatment of Tarsal Tunnel Syndrome

Different treatments are often combined to treat tarsal tunnel syndrome and they include:

• Resting the foot and staying off it encourages healing and prevents further injury
• Icing the affected area brings relief
• Shoes which are considered supportive may be recommended
• Orthotic devices such as custom shoe inserts may help with maintaining the arch and limit excessive movement
• Immobilization: This will restrict movement of the foot thereby allowing it to heal
• Medication: Anti-inflammatory drugs may help in reducing the pain and inflammation
• Injection therapy: Local anesthetic injections provide relief from pain and injecting corticosteroid can treat the inflammation
• Physical therapy such as exercises and ultrasound therapy may help in alleviating the symptoms
• Bracing is usually done for patients with flat feet, severe symptoms or nerve damage to help reduce the pressure on the foot.
• Surgery can be an option in treating tarsal tunnel syndrome. The doctor will determine if it is necessary and select the appropriate procedure or procedures often based on the cause of the condition.

Next Step

At King’s College Hospital Dubai, we focus on offering an exemplary service, from initial consultation through to final diagnosis and treatment and beyond. Our multidisciplinary team of expert doctors, nurses, physio therapists are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.