TARSAL TUNNEL SYNDROME
Robert H. Sheinberg, DPM

Tarsal Tunnel Syndrome is an entrapment or compression neuropathy of the posterior tibial nerve or its branches. This entrapment may occur on the inside of the ankle or the arch region. The resulting symptoms may occur in the ankle, rear foot midfoot, or forefoot regions.

Symptoms may include shooting or radiating pain. Numbness, burning or tingling sensation may also be present in the ankle, heel, arch or toe region. These symptoms may be increased with occupational stress or activity to the lower extremity.

Common area of pain with Tarsal Tunnel Syndrome

Distribution of Posterior Tibial Nerve

Diagnosis is suspected whenever any of these symptoms occur along the distribution of the posterior tibial nerve or its branches. The nerve is present on the inside of the ankle and the heel area. Shooting pain may be elicited when the entrapped nerve is percussed (gentle tapping of the nerve with the finger). If the diagnosis is strongly considered, it is advisable to obtain nerve conduction velocity studies. A positive test may confirm diagnosis, but a negative one does not rule it out. An MRI may be necessary to rule out space occupying lesions (tumor).

CAUSES: The posterior tibial nerve and its branches travel through the ankle and heel area in tunnels formed by bones and ligaments. The nerve may become compressed by many surrounding structures including its overlying ligament. It has been shown the hyperpronated feet (flatfoot) may increase pressure in the tarsal tunnel causing nerve compression. Inflammation of any local structure (tendonitis) may cause nerve compression. Any space-occupying lesion (tumor or ganglion) may also put pressure on the nerve causing symptoms. Varicose veins may fill in the region causing pressure on the nerve. Any condition that may cause peripheral neuropathy would make damage or irritation of this nerve more likely. This includes alcoholism, diabetes, and thyroid disorders. Radiculopathy to the L4, L5, and S1 regions in the back can produce pain in the tarsal tunnel area. People going from high heels to flat shoes on the weekend may also develop this problem.

TREATMENT: It is important to ascertain the cause of this nerve entrapment. Pronated feet need to be stabilized with orthotics. This is especially important for people who require standing or walking for long periods of time during the day. If a metabolic condition exists, the internist needs to address the patient. If a space-occupying lesion is suspected, an MRI is indicated to visualize the mass. Tendonitis or inflammatory conditions should be treated with physical therapy, rest, medication or immobilization in a cast. If treatment fails to provide relief, surgical treatment may be considered. This would consist of releasing any tight fascial (ligamentous) structures over the nerve to allow the nerve to move more freely. The results of surgical decompression are much better if it is done promptly.

<< Back To Podiatric Articles