Ways to Prevent, Treat, and Cure Tarsal Tunnel Syndrome

The posterior tibial nerve, which is one of the two branches of the sciatic nerve, provides motor and sensory innervations to the lower leg and foot muscles. It passes through the tarsal tunnel—the osteofibrous space (composed of bone and soft connective tissue) situated in the middle back part of the ankle.

Anything that causes the tarsal tunnel to narrow can consequently compress the posterior tibial nerve, hence the condition referred to as tarsal tunnel syndrome (TTS). Inflammation in a nearby tendon or blood vessel, ankle swelling due to injury, certain diseases (e.g., arthritis and diabetes), and flatfeet are some of the common culprits in tarsal tunnel syndrome.

As with any other type of nerve compression syndrome, TTS can result in irreversible nerve damage if left untreated. Thus, it pays to learn how to prevent, treat, and cure it. Read on to learn about the preventive and treatment strategies for tarsal tunnel syndrome.

Preventing Tarsal Tunnel Syndrome

It isn’t always possible to prevent the onset of TTS, especially if it is related to an underlying condition. However, there are things you can do to reduce your risk of developing the condition. These include:

  • Getting frequent breaks, to rest the feet in between extended periods of standing or walking. This helps reduce the stress on the tarsal tunnel.
  • Warming up properly before strenuous exercise, to reduce the chance of injuries to the structures in the foot.
  • Ensuring your feet have adequate support. If you have a foot problem, such as high arches, custom orthotics can help to support the foot correctly and reduce strain placed on the area.
  • Using wraps or bracing while engaging in athletic activity, especially when on uneven surfaces or during activities involving sudden changes in direction, to reduce the chances of injury.
  • Exercising, to improve strength and flexibility in the lower leg muscles and also reduce the chance of injury and stress on tendons and muscles.

Diagnosis, Treatment, and Cure

TTS is diagnosed through a comprehensive clinical exam, which includes a review of your medical history, and a number of tests, such as nerve conduction velocity (NCV) tests, electromyograms (EMGs), and/or imaging tests (X-rays, CT scan or MRI).

Treatment can vary and will depend on the severity and cause of the nerve compression.

Nonsurgical treatments for TTS may include:

  • Rest
  • Ice
  • Immobilization
  • Anti-inflammatory medications
  • Steroid injections into the tarsal tunnel to relieve pressure and swelling on the nerve
  • Bracing or a splint
  • Custom orthotics
  • Physical therapy

Custom Orthotics

Custom orthotics are shoe or heel inserts that are specifically made to address your unique requirements. Custom orthotics are used for correcting gait or irregular walking patterns, which may cause or contribute to foot, ankle, leg or back pain.

For TTS, custom orthotics may help to reduce pressure on the foot and limit movement that could cause compression on the tibial nerve.

Foot Surgery

For severe cases of TTS or if conservative treatments fail to relieve symptoms successfully, surgery may be recommended to completely resolve the condition.

Tarsal tunnel release surgery is the most common type of procedure for TTS. Tarsal tunnel release works to reduce compression on the nerve. The procedure involves the surgeon creating an opening behind the ankle that extends down to the arch of the foot. They will then divide the ligament to prevent it from pressing against the tibial nerve.

Treatment for Tarsal Tunnel Syndrome in South Texas

At The Podiatry Group of South Texas, we use a broad range of nonsurgical and surgical treatment options to effectively treat the full spectrum of foot and ankle conditions.

To learn more about our services or to schedule an appointment with one of our board-certified podiatrists for tarsal tunnel syndrome treatment, call us at the location nearest you. You can also request an appointment online.

Recognizing and Treating Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is a condition caused by repeated pressure that results in damage on the posterior tibial nerve. Your tibial nerve branches off of the sciatic nerve and is found near your ankle.

The tibial nerve runs through the tarsal tunnel, which is a narrow passageway inside your ankle that is bound by bone and soft tissue. Damage of the tibial nerve typically occurs when the nerve is compressed as a result of consistent pressure.

People with tarsal tunnel syndrome may experience pain, numbness, or tingling. This pain can be felt anywhere along the tibial nerve, but it’s also common to feel pain in the sole of the foot or inside the ankle. This can feel like:

  • sharp, shooting pains
  • pins and needles
  • an electric shock
  • a burning sensation

Symptoms vary greatly depending on each individual. Some people experience symptoms that progress gradually, and some experience symptoms that begin very suddenly.

Pain and other symptoms are often aggravated by physical activity. But if the condition is long-standing, some people even experience pain or tingling at night or when resting.

Tarsal tunnel syndrome results from compression of the tibial nerve, and it’s often caused by other conditions.

Causes can include:

  • severely flat feet, because flattened feet can stretch the tibial nerve
  • benign bony growths in the tarsal tunnel in the membrane surrounding the tibial nerve, which cause compression on the nerve
  • inflammation from arthritis
  • lesions and masses like tumors or lipomas near the tibial nerve
  • injuries or trauma, like an ankle sprain or fracture — inflammation and swelling from which lead to tarsal tunnel syndrome
  • diabetes, which makes the nerve more vulnerable to compression

If you think you have tarsal tunnel syndrome, you should see your doctor so they can help you identify the cause and create a treatment plan so that the condition doesn’t get worse. Your general practitioner can refer you to an orthopedic surgeon or podiatrist.

You can book an appointment with an orthopedist in your area using our Healthline FindCare tool.

At your appointment, your doctor will ask about the progression of your symptoms and about medical history like trauma to the area. They’ll examine your foot and ankle, looking for physical characteristics that could indicate tarsal tunnel syndrome. They’ll likely perform a Tinel’s test, which involves gently tapping the tibial nerve. If you experience a tingling sensation or pain as a result of that pressure, this indicates tarsal tunnel syndrome.

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Your doctor may also order additional tests to look for an underlying cause, including an electromyography, which is a test that can detect nerve dysfunction. MRIs may also be ordered if your doctor suspects that a mass or bony growth could be causing the tarsal tunnel syndrome.

If tarsal tunnel syndrome is left untreated, it can result in permanent and irreversible nerve damage. Because this nerve damage affects your foot, it could be painful or difficult to walk or resume normal activities.

Treating tarsal tunnel syndrome depends on your symptoms and the underlying cause of your pain.

At-home treatments

You can take anti-inflammatory medications (including nonsteroidal anti-inflammatory drugs) to reduce inflammation, which may alleviate compression of the nerve. Resting, icing, compression, and elevation, known as the RICE treatment, may also help reduce swelling and inflammation.

Doctor-prescribed treatments

Steroid injections may also be applied to the affected area to reduce swelling. In some cases, braces and splits may be used to immobilize the foot and limit movement that could compress the nerve. If you have naturally flat feet, you may want to have custom shoes made that support the arches of your feet.

Surgery

In severe, long-term cases, your doctor may recommend a surgery called the tarsal tunnel release. During this procedure, your surgeon will make an incision from behind your ankle down to the arch of your foot. They will release the ligament, relieving the nerve.

A minimally invasive surgery is also used by some surgeons, in which much smaller incisions are made inside your ankle. The surgeon uses tiny instruments to stretch out the ligament. Because there’s less trauma sustained by the tissues, the risk of complications and recovery time are both reduced.

Tarsal tunnel syndrome can be managed or cured with a wide variety of treatment options, but regardless of what the underlying condition is, it’s essential to get early treatment to prevent permanent nerve damage.

Last medically reviewed on June 26, 2017

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

How to Self-Treat Tarsal Tunnel Syndrome

T arsal tunnel syndrome (TTS), sometimes called jogger’s foot, is a relatively common cause of pain along the inside (medial) portion of your ankle. TTS can be a repetitive strain injury or an entrapment (compression) type injury.

The tarsal tunnel is a fibrous tunnel that is not structurally flexible. There is limited room for swelling inside the tunnel. This can cause nerves and blood vessels to be “entrapped” and lead to pain and other symptoms.

TTS is often caused by repeated pressure that results in damage on the posterior tibial nerve. Similar to carpel tunnel in the hand, the tarsal tunnel is located just below the medial malleolus (the large bump to the inside of the ankle). Basically, the tibial nerve branches off of the sciatic nerve and travels down the inside of the leg. It eventually runs through the tarsal tunnel, which is a narrow passageway inside your ankle that is bound by bone and soft tissue called a retinaculum.

How to Self-Treat Tarsal Tunnel Syndrome

Symptoms of Tarsal Tunnel Syndrome (TTS) include:

  • Pain can be felt anywhere along the tibial nerve, sole of the foot or inside of the ankle.
  • Pain can be pin point or diffuse extending to the heel, calf, arch or toes of the foot.
  • Pain can come on gradually or suddenly appear.
  • Pain is often described as pins and needles or as sharp shooting pains.
  • Pain may often feel as an electric shock sensation or a burning sensation.
  • Paresthesia or loss of sensation or numbness may also be present.

TTS is often mistaken for Posterior Tibial Tendon Dysfunction (PTTD) because of the location and type of pain. In order to correctly diagnose TTS, other possible conditions should be ruled out first. You may have TTS if you are experiencing the symptoms listed above and they worsen with direct pressure or firm tapping over the tarsal tunnel. The only definitive way to diagnose TTS is to have a nerve conduction study performed by your physician.

Common Risk Factors for Tarsal Tunnel Syndrome (TTS) include:

  • Direct trauma or injury (such as being kicked in soccer).
  • Overuse of the foot and/or overtraining of the tendon that causes inflammation, swelling, and pain.
  • Prolonged standing, walking, exercising or sudden increase in activity or exercise volume.
  • Training overload. Performing too high of training intensities and volumes.
    Obesity.
  • Diabetes.
  • Abnormal foot and ankle mechanics.
  • Flat feet, which cause overpronation while running.
  • Poorly fitting or worn out shoes.
  • Weak ankle muscles (particularly, the posterior tibialis or the foot intrinsic muscles that help to support the arch of the foot).
  • Weakness in the hip, pelvic, and/or core muscles causing faulty gait mechanics.
  • A change in running surfaces or environments. This is most evident when transitioning from a softer running surface, such as dirt, to a concrete running track or running downhill.
  • Running on cambered surfaces, such as the edge of a road, where overpronation can cause excessive and repeated stretch on the nerve. Alternately, a high arch can cause more compression particularly on the downhill side of the foot. Thus, compressing the tarsal tunnel and possibly leading to inflammation and symptoms.
  • Excessive dorsiflexion (toes moving towards the shinbone) during running. Those who tend to excessively heel strike can develop TTS. If the terrain (such as hill running) forces excessive dorsiflexion, then the combination of landing on the heel while the ankle dorsiflexes can increase the tarsal tunnel compartment pressure. This can cause impingement of the artery, vein, and nerve and can lead to pain or neurologic symptoms.

Initial Treatment for Tarsal Tunnel Syndrome (TTS):

This condition typically begins as an overuse syndrome with an active inflammatory cycle occurring. The initial course of treatment includes PRICE, which stands for Protect, Rest, Ice, Compression, and Elevation.

  • Protect. In more severe cases (especially those involving physical damage to the nerve), it’s necessary to protect the damaged area. This may be done through use of a walking boot or in some cases, a cast may be necessary to restrict movement completely which allows the nerve, joint, and surrounding tissues a chance to heal.
  • Rest. In this case, rest would indicate tapering down from your regular exercise activity and discontinuing running (for the short term).
  • Ice. Apply ice to the painful area. The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel pack style. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing.
  • Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response, so limit it as much as possible. A compression stocking can help to limit the amount of swelling and promote blood flow back out of the lower leg. This insures better nutrient exchange, waste removal, and limits the swelling. I particularly recommend wearing a pair during your rehabilitation phase and when tapering back into full activity. Although there are many different styles of compression stockings available, always be sure to choose a pair that is at least knee high.
  • Elevation. Depending on your pain level and the amount of swelling present, this step may be more or less beneficial.
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Depending on the severity you may also want to speak to your physician about utilizing anti-inflammatory medications such as NSAIDs (non-steroidal anti-inflammatory drugs). This class of medication can be used as a pain reliever as well as to reduce inflammation. Medications in this class include drugs such as over-the-counter Aleve and Ibuprofen or higher strength medications such as Meloxicam.

How to Self-Treat Tarsal Tunnel Syndrome (TTS):

Please refer to Tarsal Tunnel Syndrome Exercises for demonstrations of the following strategies that I recommend when self-treating TTS.

Self-mobilize the tissue. Be sure to mobilize the tissue in and around the upper leg, calf and shinbone (tibia). Take care not to be too aggressive when mobilizing right over the tarsal tunnel or you may make the pain worse. Instead, initially focus on any other mobility and myofascial restrictions in the lower legs. Utilize a foam roller to address any lower leg tightness or restrictions. I tend to use the foam roller for the larger parts of the leg including the thigh, back of the leg, calves, and buttock muscles.

Mobility bands, such as the Rogue Fitness VooDoo X Bands or EDGE Mobility Bands, are a novel way to self-mobilize the tissue of the calf, foot, and ankle. The use of mobility bands affects blood flow to the area and speeds up healing. Mobility bands also help reset some of the receptor cells in the muscle tissue that cause excessive muscle tightness. Application of the band starts at mid foot, and then wraps directly over the ankle. You will then pump your ankle back and forth for as much motion as possible in each direction. Typically, the mobility band is in place for 30-60 seconds. If you experience numbness or tingling or worsening of symptoms, please discontinue the treatment. (If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of deep compression.)

Strengthen your foot and ankle complex. Weakness in the foot and ankle muscles is a major risk factor in developing TTS. I recommend initiating a complete ankle and foot strengthening protocol.

Improve your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain on the foot/ankle complex. Practice balancing on one foot.

Gently stretch and “floss” the tibial nerve. You will need a belt or a towel to stretch the tibial nerve. Wrap the belt around the ball of your foot. Apply a forceful pull on the belt so that your foot and toes move toward your nose while tilting your foot slightly outward. While keeping this downward tension, slowly straighten your knee (as demonstrated). Repeat for 20-30 repetitions, and repeat twice a day.

Make sure you have normal range of motion in your ankle. In order to have proper foot mechanics, your ankle should have normal mobility. Your ankle should have range of motion in all directions. Also, be sure to stretch your calves so that they don’t restrict your ankle’s dorsiflexion. I typically advise at least two repetitions of holding for 60 seconds per calf stretch. Stretch both the gastrocnemius and soleus calf muscles (as demonstrated).

Address any sources of mechanical irritation and/or compression. Due to the location of the tarsal tunnel, it can be easily affected by poorly fitting shoes and/or socks. Avoid wearing socks or shoes that cause any type of rubbing or compression directly over the tarsal tunnel.

If you change running surfaces, progress slowly. If you typically run on softer surfaces, such as dirt or a running track, progress carefully and slowly to running on a harder surface (like concrete). If you run on roads, try to vary which side so that the natural camber of the road is not causing excessive strain on one foot versus the other. Overall, softer running surfaces are better for your body. If your job requires that you stand on a hard surface, adding a foam pad or rubber mat can decrease the strain on your foot and arch.

Avoid training overload. Don’t progress your training volume and/or intensity levels too quickly. TTS is most commonly diagnosed as an overuse injury. Proper training is very important to avoid overloading your body. Improper progression of training volume and/or intensity can easily lead an overuse injury like PTTD, Achilles tendinitis or other lower extremity injuries.

Add an orthotic. Additional foot control is often needed to normalize gait mechanics. Many running stores sell an over-the-counter orthotic such as Superfeet Blue Premium Insoles. The blue tends to fit most feet, but a variety of options are available for customization. In my experience, these insoles can last 1,000 to 1,500 miles easily.

If you continue to experience pain related to your foot or footwear, then you may need to consult with a physical therapist and/or podiatrist that specializes in feet and orthotics. A custom orthotic may be necessary to correctly support your foot and insure proper foot mechanics. Seek assistance from a professional such as a podiatrist or physical therapist who has experience with treating other runners.

Laser therapy. Laser therapy uses light to accelerate the body’s natural healing processes. It produces a photochemical, photothermal, and photomechanical effect. The photochemical effect is said to increase local energy production, activate enzymes, and decrease pain perception. The photothermal effect is said to increase circulation which will improve oxygen and nutrient delivery for healing. The photomechanical effect is said to increase lymphatic mobility and improve circulation as well.

Other treatments. When conservative measures fail, additional medical management may be necessary. This includes steroid injections to reduce the pain and inflammation in the area. This usually works best when you are actively working on rehabilitation to insure that the cause of TTS has been addressed. Surgery may also be needed. Tarsal tunnel surgery can be a complicated surgery. You will likely need an MRI to see what is causing the TTS. Sometimes, there are varicose veins or a cyst that are impinging on the nerve. If there is a cyst and removal is required, then the surgery should have a success rate of about 90%. If there isn’t a defined cause of the TTS (such as a cyst), then the chance of a successful surgery decreases. Surgery is best performed when there is a clear impingement in the tunnel which can be surgically fixed. Surgery is typically performed by a Doctor of Podiatry or an orthopaedic surgeon.

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Ask for help. If you’re still experiencing pain after implementing these self-treatment strategies, then it may be time to seek additional help. Other medical conditions can mimic or be associated with TTS, including foot neuropathy and radiculopathy from the lumbar spine. Your medical physician or physical therapist can help to determine if your pain is associated with other conditions or other biomechanical related issues. Your physician could also prescribe a stronger anti-inflammatory medication if necessary. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical physician’s referral (although it may be a good idea to seek your physician’s opinion as well).

RETURN TO RUNNING

As you return to running and your normal training activities, insure the following:

  • Your involved leg is as mobile and flexible as the other.
  • Your involved foot and ankle is as mobile and flexible as the other.
  • Your involved foot and ankle complex is as strong as the other leg.
  • Your ability to balance is equal in both legs.
  • You can jog, run, sprint, and jump without pain.

If you are not progressing after 3-4 weeks of implementing these treatment options, speak to your medical professional. Do not take this condition lightly. Be sure to properly address it so you don’t lose too much time with your training. As you taper back into your running program, follow these guidelines:

  • Although you will need to progress and train on uneven ground and hills, initially start with level terrain only.
  • Initially limit your running distance. I recommend starting with a distance approximately 50-75% of your pre-injury distance.
  • Initially start with a slower pace. Don’t immediately progress back into very intense running activities, such as interval or hill training, until you have worked back up to your previous running distances and paces without pain.

Tarsal Tunnel Syndrome (TTS) most commonly starts out as an overuse injury, but it can be caused by a direct trauma or injury. If the condition is left untreated, the end result can be permanent nerve damage. When this condition is caught early, it can be self-treated. For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.

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About Ben Shatto

Ben Shatto, PT, DPT, OCS, CSCS is a physical therapist who specializes in managing orthopedic conditions and strength and conditioning. Ben has been running since 2005. He shares tips on treating running injures at www.thePhysicalTherapyAdvisor.com

94 Responses to How to Self-Treat Tarsal Tunnel Syndrome

Dear Dr. Shatto, thank you so much for this detailed explanation. Actually, I’d commented before below your text on posterior tibial tendonitis as I was almost 100% sure that it was what I was suffering from due to excessive training overload. However, although I’ve given it enough time and rest (I’ve given up running completely and changed into swimming trainings) I still have a sort of oddness inside of my ankle. It’s not exactly a pain but rather a burning sensation (especially at night on the bed) and an itchy feeling. There’s no swelling or sharp pain. Following your suggestion I’ve recently begun with running exercises by practicing jogging and walking exercises (like one minute jogging followed by one minute running up to 20 minutes), and it’s completely pain free, but I still have this spread sense of oddness on my ankle, right above medial malleolus and no sharp pain on any certain point. These all make me think that I was wrong in self diagnosing my initial injury which was actually tarsal tunnel syndrome or I might’ve simultaneously developed this latter. I know it’s not easy for you to give any recommendation without realizing a physical examination, but taking into account my description, what would you suggest? Do you think I should consider to see a sports medicine doctor or physical terapist and meanwhile give up again any running exercises? I also feel this odd feeling after swimming sessions, do you think it may aggregate tarsal tunnel symptoms? It’s nothing weight bearing but rather mechanical activity. I do appreciate your kind attention in advance, and once again I thank you so much for this comprehensive text. All the best from Turkey

Hi Barish, I think you maybe correct those symptoms could definitely be tarsal tunnel syndrome. It is also possible the symptoms are originating from your lumbar spine. At this point having someone deferentially diagnose the symptoms is probably the right course of action. If it is tarsal tunnel then someone needs to determine what is doing on mechanically that is leading to your symptoms. There is always a mechanical cause it just can be difficult to figure out. But yes given the symptoms and the ongoing nature meaning it hasn’t gone away completely I would at least get an examination and a self treatment plan. Hope that helps. Ben

Dear Dr. Shatto, thank you so much for your prompt reply, it’s absolutely fabulous and praiseworthy that you respond to every single case and question with absolute care and attention. I’ve been practising some easy tibial nerve flossing exercises for couple of days and I feel relatively better. If the symptoms persist, however, I’ll definitely go to see a physician as you recommend. Once again thank you so much and wishing you all the best.

Source https://www.thepodiatrygroup.com/2021/07/02/ways-to-prevent-treat-and-cure-tarsal-tunnel-syndrome/

Source https://www.healthline.com/health/tarsal-tunnel-syndrome

Source https://www.marathontrainingacademy.com/tarsal-tunnel-syndrome

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