Common Symptoms of Tarsal Tunnel Syndrome

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Tarsal tunnel syndrome is a condition caused by compression of a nerve at the back of the ankle, called the posterior tibial nerve. This nerve passes under a band of tissue right below where the bone protrudes on your inner ankle, creating the tarsal tunnel. And when this nerve gets compressed, it causes unwanted symptoms. In this way, tarsal tunnel syndrome is similar to carpal tunnel syndrome at the wrist.

It's a relatively rare syndrome, but it can negatively affect your quality of life. Here, we'll explain the symptoms of tarsal tunnel syndrome, as well as what to do if you have them.

What causes tarsal tunnel syndrome?

Anything that compresses the posterior tibial nerve or one of its branches can cause tarsal tunnel syndrome. There are bothinternal and external causes.

Internal causes are things that can compress the nerve within the tarsal tunnel. Examples include:

• Abnormal masses - such as cysts, neuromas, or lipomas - which can press on nearby parts of the ankle

• Tendon problems, such as or tenosynovitis or tendinopathy (including tendonitis)

• Osteophytes (bony spurs)

• Soft tissue irregularities (thickened tissue overlying the tarsal tunnel)

External causes are things that can compress the nerve from outside the tunnel. Examples include:

• Tight shoes

• Ankle injury or trauma

• Conditions, such as rheumatoid arthritis and diabetes, which cause inflammation and swelling around the nerve

• Scarring after surgery or injury

• Lower leg swelling

What are the symptoms of tarsal tunnel syndrome?

Tarsal tunnel syndrome can cause pain and other symptoms. These symptoms tend to follow the course of the nerve, which travels from behind the inside ankle bone below the bony prominence and down into the bottom of the foot. Symptoms of tarsal tunnel syndrome include:

• Pain: This is the most common symptom. The pain can feel like a burning or shock-like sensation. It can occur on the inside of the ankle and in the foot and toes.

• Numbness: Compression of the posterior tibial nerve also causes numbness and tingling. Like pain, numbness can travel down into the bottom of the foot or even up into the calf muscle.

• Weakness: If compression of the nerve is long-lasting, it can affect the muscles of your toes. This can cause weakness when bending your toes.

Symptoms tend to worsen throughout the day and when you stand, walk, or perform prolonged physical activities. You could also experience nighttime pain that wakes you up from sleep.

You might feel:

• Cramping of the arch of the foot

• Pain or weakness when moving your big toe (in severe cases)

• Pain with external pressure on the nerve (such as tapping the nerve)

• A bump or swelling over the ankle bone (medial malleolus), if there's an internal cause of tarsal tunnel syndrome

What can make tarsal tunnel syndrome worse?

Pressure on the posterior tibial nerve can make tarsal tunnel symptoms worse. This can happen with standing or walking for a long period of time.

Similarly, as research suggests, any movement that compresses or creates more tension on the nerve can make symptoms worse. These movements include:

• Lifting your foot up toward the knee (foot dorsiflexion)

• Turning your foot outward (eversion), which stretches the nerve

• Stretching your toes

• Pushing your foot down, like when you're pushing down on a gas pedal or when wearing high heels (plantarflexion)

• Turning your foot inwards at the ankle, with the outer edge of your foot pointing down and outwards (inversion)

Recent research shows that plantarflexion and inversion for long periods of time can also compress the nerve.

How can you manage tarsal tunnel syndrome symptoms at home?

There are several things you can do at home to help alleviate tarsal tunnel syndrome symptoms.

Update your footwear

First, it's important to keep your foot in a neutral position to minimize stress on the nerve. You can do this by wearing shoes with good arch support or using orthotics, depending on the shape of your foot. Avoid tight-fitting shoes, heels, or flats, if you'll be walking for a long time.

Also, take a break from any activities or exercises that make your symptoms worse.

Stretch and strengthen

Physical therapy and home exercises can help reduce pain and improve foot and ankle range of motion. This includes both stretching and strengthening the muscles of the lower leg, ankle, and foot. Working on single leg balance can help with overall lower leg strength.

Reduce swelling and inflammation

Icing your ankle and taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help with inflammation. Anti-inflammatory creams may also help decrease pain and swelling.

When should you seek care for tarsal tunnel syndrome?

If you think you have tarsal tunnel syndrome based on the information above, it makes sense to try at-home recommendations first. It'll likely take at least a few weeks to see real improvement. So, don't expect results overnight.

If your symptoms don't improve with home treatments, you might consider seeing a specialist, like an orthopedic surgeon or a sports medicine physician. They can confirm the diagnosis with a physical exam and additional testing. This could include advanced imaging, such as magnetic resonance imaging (MRI), to identify a reason for compression. It could also include nerve testing to see how severely the nerve is being compressed.

Depending on what they find, a specialist can recommend other treatment options. For example, an injection could relieve pressure on the nerve. In some cases, surgery can release the nerve from whatever is compressing it.

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