Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome

Tarsal Tunnel SyndromeTarsal Tunnel Syndrome

Tarsal tunnel syndrome is a rare neuropathy which occurs when abnormal pressure is exerted onto the tibial nerve, which is found within the foot. The condition can affect people at any age, and is more common in women than men.

Where is the tarsal tunnel?

The tarsal tunnel is a hollow area that is found on the inside of the ankle.  It is surrounded by the bones that form the ankle (the medial malleolus, talus, and calcaneus) and covered by a think band of fibrous tissue called the flexor retinaculum.  The tibial nerve which is the main cause of the tarsal tunnel syndrome as well as tendons, arteries and veins all pass through this tunnel to reach the bottom of the foot.

Causes of tarsal tunnel syndrome (TTS)Tarsal Tunnel Syndrome Treatment

Some cases of tarsal tunnel syndrome (TTS) have unknown causes. However, anything that constricts the space within the tarsal tunnel can increase pressure within the area and lead to strain of the tibial nerve. This leads to painful symptoms within the foot. Some of the causes include:

  • Traumas such as fractures, dislocation or stretch injuries
  • Swollen varicose veins
  • Excessive taining or activities such as; walking, standing, running and other strenuous activities
  • Fibrosis, Tendonitis, or Joint stiffness
  • Inappropriate footwear
  • Muscle weakness
  • Poor foot biomechanics incl. heel varus or valgus (rolling in or out of the heel at the ankle)
  • Space-occupying lesions in tarsal tunnel region such as edema,ganglion, tumors,osteophytes
  • Systemic conditions such as diabetes mellitus, arthritis

Symptoms of tarsal tunnel syndrome

One of the main symptoms of tarsal tunnel syndrome is a burning or tingling sensation in the sole of the foot. Symptoms usually get worse with forced eversion (the movement of the sole of the foot away from the midline) and dorsiflexion (upward movement of the foot). Activities such as long periods of standing and walking aggravate the symptoms, while rest relieves the pain. The course of the nerve is tender by touch. In more severe cases, you may feel numbness and weakness in your feet, as well as a lack of stability in the ankle.  Tarsal tunnel syndromeTTS can display symptoms similar to those of plantar fasciitis as these patients also experience plantar heel pain.

Treatment of tarsal tunnel syndrome

The success rate of treatment is largely dictated by patient compliance. Patients should initially avoid aggravating activities. If treated properly, the symptoms of this syndrome can usually be relieved with non-surgical procedures. Treatment for tarsal tunnel syndrome (TTS) depends on the cause of the pressure on the nerve and may include a combination of the following treatments:


  • Ice
  • Moist heat
  • Joint mobilization
  • Ultrasound
  • Laser Therapy
  • Massage
  • Iontophoresis
  • Stretching exercises: To increase flexibility in the muscles and to glide the tibial nerve within the tarsal tunnel
  • Strengthening exercises: Posterior tibialis
  • Custom Orthotics: For cases of pronation (flattened arches); ankle bracing, CAM walker, plantar arch taping, medial heel wedge
  • Biomechanical correction
  • Activity modification advice
  • Acupuncture
  • A gradual return to activity program

Medical treatment:

  • Medications: NSAIDs
  • Corticosteroid Injections
  • Surgery: Posterior tibial nerve decompression, cryosurgery

The professional Physiotherapists at Ace Physio can help relieve your symptoms of tarsal tunnel syndrome. Ace Physio is a highly respected Physiotherapy clinic in downtown Toronto. It offers skilled, individualized treatment and rehabilitation plans by expert Physiotherapists using leading-edge techniques and equipment. Call Ace Physio Clinic today at 416-900-6653 to book your appointment.


About the Author

Brad SaltzBrad is a Registered Physiotherapist at Ace Physio, a highly respected Physiotherapy clinic in downtown Toronto. Ace Physio provides high quality one on one Physiotherapy that combined state-of-art technology such as; Shockwave Therapy, Laser Therapy, and Spinal Decompression with traditional Physiotherapy.View all posts by Brad Saltz