Recognizing the symptoms of tarsal tunnel syndrome and how it’s treated

From controlling your senses to helping you walk, the nerves in your body are essential for many functions. On an average day, you shouldn’t notice your nerves working hard – or at all. But when there’s something wrong, it can interfere with your daily life.

Tarsal tunnel syndrome is a condition that can develop from repeated pressure on the posterior tibial nerve, a nerve that’s found near your ankle. A number of things can cause it, and some of the causes can’t be avoided. The number one symptom that people experience is pain. Fortunately, there are things you can do to relieve the pain and other symptoms you may experience.

Below, we’ll help you recognize the symptoms of tarsal tunnel syndrome and explain its common causes. We’ll also cover ways to prevent it from occurring and go over treatment options that can help alleviate your pain.

What tarsal tunnel syndrome is and symptoms you can experience

The tibial nerve is located in the ankle and runs through the tarsal tunnel – a passageway in your ankle that is made up of bone and soft tissue. Tarsal tunnel syndrome can develop when your tibial nerve is consistently compressed or injured, causing pain and other noticeable symptoms.

This pain can be felt anywhere along the nerve, as well as on the inside of the ankles and the soles of your feet. Pain often gets worse after prolonged periods of standing. It may feel like:

• Tingling, burning or a sensation similar to an electrical shock, typically felt on the bottom of the feet
• Pins and needles feeling in the foot or toes
• Sharp or shooting pain in the ankle, foot or toes
• Noticeable weakness in the muscles of the foot
• Pain or tingling in the feet, even when at rest (this is most common for people who have had tarsal tunnel syndrome for a long time)

Tarsal tunnel syndrome has several causes

Overuse of the feet – like from running or jogging frequently – is the cause for the majority of people diagnosed with tarsal tunnel syndrome. And more than 40% of people who develop it have a history of injuries to the feet. Other causes include:

• Flat feet – Also called a fallen arch, this is when the foot has little to no arch. Flat feet can cause your heel to tilt inwards, which can strain or compress the tibial nerve.
• Injury or trauma to the feet – Ankle sprains, fractures and breaks usually cause swelling and inflammation, which put pressure on the tibial nerve.
• Ongoing medical conditions – Certain conditions, like diabetes, arthritis and hypothyroidism, can cause inflammation and swelling, which can compress the tibial nerve. Gout, which also causes inflammation in the joints, can also contribute to tarsal tunnel syndrome, but it’s rare.
• Growths – Conditions that crowd the tarsal tunnel, such as bone spurs, ganglion cysts, varicose veins, lipomas and Morton’s neuroma, can all put you at risk of developing tarsal tunnel syndrome.
• Pressure on the nerve from shoes – Nerve pressure can occur when wearing shoes that are too tight or rigid, which compresses the tibial nerve.

Causes of foot pain that can be mistaken for tarsal tunnel syndrome

Because tarsal tunnel syndrome is uncommon, the symptoms are often misdiagnosed or undiagnosed. There are many causes of foot pain, but two that have similar symptoms to tarsal tunnel syndrome include:

• Plantar fasciitis – This is caused by repetitive use and pressure on the plantar fascia, which connects your heel to your toes. The symptoms are similar to tarsal tunnel syndrome, and the pain is felt closely to the tibial nerve, so tarsal tunnel syndrome is often misdiagnosed as plantar fasciitis.
• Morton’s neuroma – Thickening of the tissue around the nerves leading to your toes can cause pain and inflammation similar to tarsal tunnel syndrome. But where tarsal tunnel syndrome is largely caused by overuse and injury, Morton’s neuroma is most commonly caused by too tight and improperly fitting footwear.

How long does tarsal tunnel syndrome usually last?

At the onset, the pain you experience from tarsal tunnel syndrome can be mild and sporadic, so you may be able to deal with it. As it progresses, more pressure is placed on your tibial nerve, causing frequent, longer-lasting pain. Without treatment to stop or slow the condition, it can cause nerve damage, lifelong pain and discomfort.

How tarsal tunnel syndrome is diagnosed

Since there’s no specific test to determine tarsal tunnel syndrome, your doctor may begin by asking about the pain and other symptoms you may be experiencing. Then, they’ll perform a physical exam to assess your ankle and see if you have any visible injuries. Other diagnostic tests include:

• A Tinel’s test – This simple and noninvasive test involves repeatedly tapping the tarsal tunnel to produce a feeling of “pins and needles.” If you feel pins and needles, that’s called a positive Tinel sign, and it could be an indicator of nerve compression or damage
• Electromyogram (EMG) or nerve conduction study – Electrical impulses are used to measure your nerve function and can help determine the cause of your symptoms.
• Magnetic resonance imaging (MRI) or ultrasound – These look at the soft tissues in the body and can help determine if there’s injury or nerve damage that’s putting pressure on your tibial nerve.
• X-ray – While X-ray can’t detect nerve compression or damage, it can determine if a fracture or a break is causing your symptoms.

At-home and over-the-counter methods are usually the first steps when treating tarsal tunnel syndrome. If other methods haven’t helped your symptoms, your doctor may recommend surgery, but that’s rare.

Relieve symptoms with at-home methods

Oftentimes, getting off of your feet and resting them for prolonged periods of time is the best way to relieve symptoms. Other things that can help include:

• Icing the affected area – Use ice packs on the affected area for 20 minutes a few times a day. This can help with swelling, inflammation and pain.
• Taking pain relievers – Over-the-counter pain relievers like ibuprofen can reduce swelling and help with pain.
• Ankle compression and elevation – Elastic bandages or a brace around your ankle can help keep it supported, which in turn can help ease pain. And elevating your feet above your heart can help reduce swelling and inflammation.

Symptoms can be reduced with physical therapy

While a physical therapist is beneficial, physical therapy to help your symptoms doesn’t necessarily have to happen in a clinic. Stretching and other types of therapy can be done anywhere and at any time:

• Ankle stretches – Strengthening the structure of your ankle can help relieve symptoms. Try using a resistance band to gently stretch and manipulate your ankle, or perform ankle rotations to improve your range of motion.
• Leg stretches – If the muscles of your lower legs are weak or tight, it can contribute to your symptoms but doing gentle leg and calf stretches can help. Wall stretches, chair stretches and yoga poses like downward-facing dog all focus on your lower legs, which can help relieve pain and swelling.
• Heel raises – While holding on to a solid object, lift both heels, hold for five seconds and then slowly lower yourself back to the ground. Aim for three sets of 10 reps per day, as these help strengthen your tibial tendon.

Treating tarsal tunnel syndrome with medical devices

Devices that can help your symptoms may be prescribed or purchased over the counter, including:

• Braces, splints or casts – Supportive devices like braces or splints can help limit movement that can further irritate your nerve. And for more severe cases of tarsal tunnel syndrome involving nerve damage, casting can completely restrict movement, allowing the nerve and surrounding tissues to heal.
• Orthotics and arch supports – These can help your feet maintain a proper arch and reduce movements that may put pressure on the nerve. Motion-controlled shoes can also be used to help prevent your foot from rolling.

Your doctor may recommend tarsal tunnel release

Depending on your symptoms, your doctor may suggest cortisone shots with a local anesthetic to temporarily relieve pain and reduce swelling. However, if you’re still experiencing severe symptoms after other treatments, your doctor may recommend tarsal tunnel release.

During this procedure, a surgeon makes a small incision along your inner ankle and the bottom of your foot, then divides the ligament that is putting pressure on your tibial nerve. This will relieve pressure and improve blood flow to the area, reducing or eliminating the tarsal tunnel syndrome symptoms.

Simple ways to help prevent tarsal tunnel syndrome

It isn’t possible to completely prevent tarsal tunnel syndrome, but you can take steps to lower your chances of developing it:

• Warm up before you work out – This is a good tip for whole body health, but it’s especially important for your feet as it can help reduce the chances of injuries that can aggravate the tibial nerve.
• Take regular breaks – If you have a job or activities where you’re required to stand or walk for long periods of time, make sure you’re taking regular breaks where you can sit, rest and elevate your feet, and ice the affected areas. And if you run, jog or perform physical activities where your feet get heavy use, give them ample time to rest and recover between workouts.
• Stretch your ankles and feet regularly – Performing any type of physical therapy to keep your muscle and ligaments strong and flexible can help lessen stress on tendons and muscles, and reduce your chance of injury.
• Wear shoes that fit properly – While overuse and injury are the most common reasons tarsal tunnel syndrome develops, wearing shoes that aggravate your feet can be a big part of the problem as well. Make sure you’re wearing shoes that are supportive and sturdy without being rigid, and pick shoes that give your tibial nerve plenty of breathing room.

If you’re experiencing foot or ankle pain, reach out to your doctor

It’s no fun to walk when you’re in pain. It’s important to treat your symptoms, as tarsal tunnel syndrome can cause you to experience permanent and irreversible nerve damage, foot deformities, and permanent movement and sensation loss in the toes and feet.

If you have foot pain that’s interfering with your daily life, make an appointment with one of the board-certified podiatrists at HealthPartners. They can help by listening to any concerns you may have, answering your questions about symptoms you are experiencing, and working with you to provide treatment options that can help alleviate your pain.