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Tarsal Tunnel Syndrome

By Dr. Ricard Izzo

Most everyone today has heard of carpal tunnel syndrome. This is an overuse injury in the wrist that is most prevalent in workers with repetitive stress jobs. Tarsal tunnel is a less common condition that affects the ankle and foot. The floor of the tarsal tunnel is made up of the medial ankle, while the roof is a thick band of connective tissue called the flexor retinaculum. Traveling through the tunnel are the artery, vein, tibial nerve and several tendons that supply the foot.

Anything that takes up space in the tunnel or stretches the tibial nerve, causes nerve irritation in the form of tingling and burning in the sole of the foot. In extreme cases weakness of the muscles of the foot can result.

Increased activity causes the burning to get worse while rest alleviates it. People with flat feet are more at risk of developing tarsal tunnel due to the fact that the nerve is now stretched and compressed while traveling through it. Any shortening of the tibialis postierior, flexor digitorum longus, or flexor hallucis longus muscles can cause inflammation of the tendons that travel through the tunnel and ultimately irritate the tibial nerve. Other causes include direct compression from the medial counter of sneakers, blunt trauma, and systemic swelling. A positive Tinel's sign (direct pressure over the nerve causing referral of pain into the sole), or nerve conduction study are definitive for tarsal tunnel syndrome, although the clinical symptoms are usually enough for proper diagnosis. A cyst, rheumatoid arthritis, or diabetes can also cause this condition.

Treatment for tarsal tunnel syndrome first requires pinpointing what caused it. Overuse injuries usually have some biomechanical abnormality as a cause that requires normalizing. Does this sound familiar?

With tarsal tunnel rest usually relieves the burning, while ultrasound and electric stimulation can hasten recovery time by decreasing inflammation. I would not suggest cryotherapy (ice) for this as the nerve lies just beneath the skin and may be susceptible to damage. Custom orthotics will help prevent over pronation which is the biomechanical abnormality causing the overuse.

Next, modify activity by decreasing intensity, duration, and distance by 30%. Usually non-weight bearing activity does not aggravate the condition. However I have seen where swimming increases symptoms. Next get aggressive conservative treatment ASAP. Deep soft tissue work should be done on the area to decrease any adhesions of the foot flexors. With numbness ALWAYS get a thorough evaluation to make sure that it is not a serious condition. In the end, with treatment tarsal tunnel is only a minor inconvenience.

Dr. Richard A. Izzo
(914) 251-1223
r.izzo@worldnet.att.net