Tarsal tunnel syndrome: A guide for patients

What is tarsal tunnel syndrome?

Tarsal tunnel syndrome happens when the posterior tibial nerve is squashed as it passes on the inside of the ankle, beneath the fibrous band known as the flexor retinaculum.

What are the symptoms?

When the nerve is compressed it causes pain, a burning sensation, tingling and sometimes numbness on the sole of your foot.

Tapping the inside of your ankle can cause symptoms to move into the arch of the foot and/or toes. This is called a tinel’s sign and helps your healthcare professional confirm the diagnosis.

Symptoms may also be aggravated by moving your ankle up and down, called a position of extreme dorsiflexion.

What causes the problem?

If you have flat feet you have an increased risk of developing this problem. This is because the change in shape of the rear foot, lead to both stretching and compression of the posterior tibial nerve.

It can also be caused if there is inflammation on the inside of the ankle. This may be from a previous injury or overuse of tendons. Occasionally it may be caused by a cyst or ganglion pressing on the nerve.

What should I do if I have tarsal tunnel syndrome?

Rest, or at least reduce your activity, to allow the symptoms to settle naturally. If you would like to walk to maintain your fitness, avoid walking up hills and keep to flat ground. Avoid wearing flat shoes and wear a pair with a 2cm or ¾ inch heel, as this will help to reduce the compression on the nerve. You can also buy medication from the pharmacy to reduce inflammation if the inside of your ankle is swollen.

Can treatment help?

An insole to change the rear foot position when standing, and walking can help to relieve the pressure on the nerve and therefore help with the symptoms. Laser therapy may also help, though it is important to correctly target the injured nerve for it to be successful. If your symptoms do not settle, it is sometimes necessary to consider surgery to ease the pressure on the nerve.

Do I need a scan?

Not always. If your symptoms do not show signs of improving with reduced activity and an insole, then an ultrasound or MRI scan may be considered to see if there is a cyst, ganglion or another tendon that may be provoking the problem. If any of these are found you may need surgery.