What to Expect After Tarsal Tunnel Surgery and Tips to Help You Recover

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Tarsal tunnel syndrome (TTS) can happen when the posterior tibial nerve is compressed as it passes through the tarsal tunnel. It can cause symptoms like burning on the bottom of your foot, numbness, or weakness in the muscles of your foot.

There are many nonsurgical treatment options to help with TTS, like exercises, activity modification, and orthotics. But when these conservative treatment options don't bring enough relief, the next step is often tarsal tunnel surgery.

The most common type of tarsal tunnel surgery is called a posterior tibial nerve decompression surgery. The goal of surgery is to clear out anything that's putting pressure on your tibial nerve. While recovery can feel slow, it's important to focus on regaining strength and mobility in your foot and ankle. Here's what you need to know to maximize your recovery.

Tarsal tunnel surgery recovery timeline

TTS will often get better with conservative treatment options. But some will need tarsal tunnel surgery to get rid of symptoms and improve functioning. There are different options for tarsal tunnel surgery, including open release (the most invasive option) or minimally invasive options.

The specific recovery timeline will look different for everyone after tarsal tunnel surgery. It can depend on several things, for example:

• How long you had your symptoms

• The details of your surgery

• Other medical conditions that can affect healing (like diabetes or arthritis)

• Other foot-related injuries or conditions (like plantar fasciitis or joint deformities)

• Activity and fitness levels prior to surgery

Check in with your care team for a better idea of what to expect during your recovery. But in the meantime, there are some general milestones that you can expect in the weeks and months after surgery.

Week 1

During the first week it's important to focus on rest, pain and swelling management, and joint protection. You'll have:

• A dressing or bandage in place

• Pain and swelling in your ankle and foot

• Limited mobility with a boot, surgical shoe, or crutches to limit weight bearing

• Driving restrictions, so be sure to plan ahead

Weeks 2 to 3

It's still important to focus on protecting your ankle and healing. During this time you may:

• Start walking again without support or a boot (but there may be exceptions)

• Have some residual swelling and pain

• Start noticing improvement in your TTS symptoms (but this varies by person)

• Check back in with your care team for a follow-up, and get your stitches removed (if needed)

Weeks 4 to 6

During this time, you'll want to start focusing on regaining the strength and mobility in your foot and ankle. Once your incision is fully healed and your surgeon clears you for more activity you may:

• Gradually get back to your daily activities, as tolerated

• Experience an increase in ankle/foot pain or swelling as your activity levels increase

Week 6 and beyond

Everyone's recovery timeline will look different, depending on prior activity level. Some research shows that, on average, it can take up to 9 weeks to get back to your daily and work activities. And it can take a few months to a year to fully recover from tarsal tunnel surgery.

Some swelling and discomfort can stick around for months. And it may take up to a year for you to feel fully comfortable with higher-impact activities like running.

Tips to speed up your healing process

During the first few weeks of recovery it's a good idea to focus on protecting your ankle and nerve, while also controlling pain and inflammation. This will help to speed up your recovery, and set yourself up for success in the later stages of recovery.

Try these tips to speed up your healing process:

• Take prescription and over-the-counter (OTC) medications as directed.

• Follow all your postoperative instructions.

• Eat plenty of nutritious foods to support your body as you heal.

• Elevate your foot, and use an ice pack or cold therapy to help with pain and swelling in your ankle.

• Try some gentle, pain-free movement to help encourage circulation and keep your joints and muscles from becoming too stiff as you rest - just be sure to stick to your postoperative instructions.

• Schedule an evaluation with a physical therapist as soon after your surgery as possible.

What are the side effects of tarsal tunnel surgery?

There are only a few known side effects or complications after tarsal tunnel surgery. Most folks do really well as they recover. If your surgeon was able to determine the cause of compression, and they were able to remove pressure from the nerve, symptoms of TTS will usually improve soon after surgery. But it can take time to fully heal and regain strength and confidence in your ankle again.

The main side effects of tarsal tunnel surgery include:

• Problems with wound healing

• Infection

• Scar tissue problems, like tightness, pain, or adhesion formation

How do you prepare for tarsal tunnel surgery?

To help prepare for, and immediately after, tarsal tunnel surgery, try these things to set you up for a smoother recovery:

• Talk with your surgeon beforehand. They'll tell you what medications and foods to avoid before your surgery.

• Arrange for someone to drive you home. After surgery, and in the first few days after surgery, you'll probably have driving restrictions.

• Stock up on supplies beforehand. This could include any over-the-counter (OTC) pain medication, easy-to-prep meals, stool softener (to ease postsurgical constipation), or any other post-op care items you may need.

• Arrange a sitter for your pets. In the first few days after surgery, it may help to have someone to help look after your pets. This will be one less thing you have to think about as you focus on recovery. And if they are with a trusted sitter, they won't be in the way to accidentally trip over.

• Make sure your follow-up appointments are on the calendar. This may include a follow-up with your surgical care team and/or physical therapist (PT). By making sure these appointments are set in advance, your care won't be delayed in any way.

How do you regain strength and mobility after tarsal tunnel surgery?

To regain strength and mobility after tarsal tunnel surgery, it's important to focus on a variety of exercises and activities. This will help to support your ankle and nerve as you heal, and minimize the risk of reinjuring yourself. It would be good to include:

• Stretches to improve the range of motion and flexibility in your hips, knees, ankles, and feet

• Resistance exercises to build strength and endurance in your ankle and foot

• Neuromuscular re-education exercises to normalize movement, balance, and proprioception in your feet

• Functional and/or sport-specific exercises

As you ease back into activity, it's important to do so gradually. Check back in with your healthcare professional if you start noticing an increase in your pain, or a return of your symptoms.

Is physical therapy recommended after tarsal tunnel surgery?

Unfortunately, high-quality research for postoperative recovery from tarsal tunnel surgery is limited. Rehabilitation following surgery is typically impairment-based. This means that the exercises and specialized treatments that are best for your recovery depend on your specific limitations. But it can be hard to know exactly what is best, without guidance from a qualified healthcare professional.

To help speed up your healing process, it's important to see a physical therapist to help guide your recovery. They'll teach you everything you need to know about your recovery. They'll also help you:

• Safely ease back into activity and exercise

• Help you avoid injury as you build strength and mobility

• Create a personalized exercise program

• Identify and monitor any risk factors that could cause your TTS to return

• Learn how to minimize swelling, pain, and scar tissue formation

• Improve balance and restore normal movement in your foot and ankle

• Find supportive shoes, orthotics, or heel wedges to support the mechanics of your foot

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