Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.

Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist.

Symptoms

The inside of the ankle may be tender to touch.
Burning pain, in the arch heel and sometimes the toes.
Pins and needles or numbness in the sole of the foot.
Deformity of the ankle

Causes

Tarsal tunnel syndrome can be both idiopathic, meaning it occurs spontaneously for apparently no reason, or it can be associated with a traumatic injury.

Causes include:

Osteoarthritis – this is wear and tear of the bones in the ankle joint, possibly as a result of an old injury.

Rheumatoid arthritis – is an autoimmune disease. Your immune system attacks the cells that line your joints, making them swollen, stiff and painful.

Overpronation – where your foot rolls in or flattens too much when you walk or run.

Tenosynovitis – is inflammation of the sheath which surrounds the tendon.

Talo-navicular coalition – fusing of two of the tarsal bones.

Cyst or ganglion – in the tarsal tunnel is a small lump which attaches to a ligament or tendon.

Anatomy

Tarsal tunnel syndrome occurs when the posterior tibial nerve which passes down the inside of the ankle becomes compressed or trapped. The nerve passes along a passage called the tarsal tunnel, just below the medial malleolus. If you overpronate when you walk or run then this can contribute to the compression of the nerve. Because overpronation is a key factor, it is common for the problem to occur in both feet at the same time. Where the condition occurs spontaneously in people involved in running or running based sports, then overpronation is the most frequent cause.

Treatment

The aim of tarsal tunnel syndrome is to reduction inflammation, correct biomechanical dysfunction, then a gradual return to normal activity levels.

Once the initial pain and inflammation have gone then a full rehabilitation program can begin.

Stretching exercises may include stretching for the calf muscles as well as the plantar fascia under the foot.

Strengthening exercises are similar to that of an ankle sprain but may focus more on inversion strengthening.

For stubborn and persistent cases, surgery may be required to decompress the nerve. The operation aims to decompress the nerve by freeing the soft tissue structures in the area, creating more space for the nerve.

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