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Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome (TTS) describes the extremely painful compression of the tibial nerve as it passes through a narrow passage on the inside of the ankle (the tarsal tunnel) which is created by the position of the bones and connective tissue.


The tarsal tunnel is located right below the bony bump (medial malleolus) on the inside of the ankle, near the back of the heel. Tendons, arteries and nerves all pass through this channel, and it is secured by a connective tissue sheath called the flexor retinaculum that covers the top of the channel.

The tibial nerve, one of the nerves that provides sensation to the feet, passes through this tunnel and splits into two branches - the medial and lateral plantar nerves.

What causes Tarsal Tunnel Syndrome?

Occasionally, Tarsal Tunnel Syndrome occurs without a definite cause. Usually, it can be linked to one or several of the issues below:

  • Inflammation from systemic conditions such as arthritis or diabetes
  • Ankle injury
  • Abnormal foot alignment or position
  • Inflammation of structures within the tarsal tunnel
  • Repetitive impact activities such as running
  • Abnormal growth or cyst within the tunnel
  • Tarsal coalition

What does it feel like?

On the inside of the ankle, as well as the heel and bottom of the foot, those with TTS may experience:

  • Pins and needles
  • Numbness
  • Swelling
  • Burning
  • Tingling
  • Pain

Symptoms can occur gradually or come on quickly and are often aggravated by movement. Because the tibial nerve is responsible for sensation in the heel and the bottom of the foot, this is where neural symptoms (burning, tingling, numbness) are felt. Pain may spread into the arch and be interpreted as heel pain. Being able to pinpoint the symptomatic areas helps locate the spot where the nerve is compressed and which makes treatment more precise.

How is it treated?

Initially, to manage the painful symptoms, we recommend resting and elevating the affected foot, as well as using ice and anti-inflammatories.

The treatment of tarsal tunnel syndrome involves treating the particular cause of the nerve compression. We conduct a thorough biomechanical examination to assess the function and characteristics of your feet and legs to deduce the likely causes of your TTS. Your treatment plan may include:

  • Orthotics to increase space within the tarsal tunnel by altering the alignment of the foot, relieve pressure from the tibial nerve, and correct any misalignments that are causing the symptoms
  • Appropriate footwear to ensure it is keeping your foot in a good, stable and supported position that doesn’t aggravate your symptoms
  • Physical therapy (stretching and strengthening) to rehabilitate the foot and its musculature
  • Gait retraining to reduce irritation within the tarsal tunnel 
  • Dry needling or mobilisation to improve movement in the foot and ankle and reduce compression within the tarsal tunnel

Because permanent nerve damage can occur if proper care is not taken, it is essential to seek treatment if you suspect you may have Tarsal Tunnel Syndrome.

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