Tarsal Tunnel Syndrome

Overview

what it is and why it matters

Tarsal tunnel syndrome is a pinched nerve at your ankle. The tibial nerve runs down the inside of your ankle through a narrow canal made by bone on one side and a tough fibrous band on the other (the tarsal tunnel). Squeeze that nerve and you get the symptoms. It is the foot's version of carpal tunnel. The squeeze can come from a cyst, a fatty growth, or a varicose vein taking up space in the canal; from a flatfoot pulling the nerve into a stretched position; from scar tissue after an old ankle injury; or sometimes from no obvious cause at all.

The classic symptoms are burning, tingling, or numbness on the bottom of the foot, often worse at night or after long stretches of standing.

How We Make the Diagnosis

exam first, imaging second

A focused physical exam of the ankle points to the diagnosis. Nerve-conduction studies (NCS/EMG) confirm the diagnosis and tell us how severely the nerve is being squeezed. MRI or ultrasound looks for a cyst or other space-taking lesion in the tunnel. Tarsal tunnel is one of those diagnoses that gets both over-called and missed; careful NCS interpretation and a thoughtful exam matter.

How We Treat It

how care progresses

Orthotic support

An arch-supporting insert lifts the inner side of your foot, which takes the stretch off the tibial nerve in flatfoot-driven cases.

NSAIDs / neuropathic agents

An over-the-counter anti-inflammatory like ibuprofen helps with the surrounding inflammation, but the burning and tingling itself responds better to a nerve-pain medication like gabapentin or low-dose amitriptyline.

Corticosteroid injection

An ultrasound-guided steroid injection placed precisely around the nerve calms the inflammation in the tissue surrounding it.

When Surgery Is on the Table

if non-operative care isn't enough

When NCS confirms the nerve is compressed and there is a clear space-occupying lesion to remove, or when months of bracing and injections have not quieted the symptoms, surgical decompression is the answer. The procedure opens the fibrous band over the nerve to give it more room, and removes any cyst or lesion that is pressing on it.

Frequently Asked

questions we hear in clinic

What exactly is the tarsal tunnel?

A narrow canal on the inside of your ankle, made by bone on one side and a tough fibrous band on the other. The tibial nerve runs down the inside of your ankle through this canal. Squeeze that nerve and you get the symptoms.

Is this the same as carpal tunnel syndrome?

It is the foot's version of carpal tunnel. Here the squeezed nerve is the tibial nerve, and the narrow canal it runs through (the tarsal tunnel) is at the inside of the ankle.

What causes the nerve to get squeezed?

The squeeze can come from a cyst, a fatty growth, or a varicose vein taking up space in the canal; from a flatfoot pulling the nerve into a stretched position; from scar tissue after an old ankle injury; or sometimes from no obvious cause at all.

What do the symptoms feel like?

The classic symptoms are burning, tingling, or numbness on the bottom of the foot, often worse at night or after long stretches of standing.

How is the diagnosis confirmed?

It starts with a focused physical exam of the ankle. Nerve-conduction studies (NCS/EMG) confirm the diagnosis and show how severely the nerve is being squeezed, and MRI or ultrasound looks for a cyst or other space-taking lesion in the tunnel. Tarsal tunnel is one of those diagnoses that gets both over-called and missed; careful NCS interpretation and a thoughtful exam matter.

What treatments come before surgery?

The treatment path moves through three steps. First, orthotic support: an arch-supporting insert that lifts the inner side of your foot, which takes the stretch off the tibial nerve in flatfoot-driven cases. Second, medication: an over-the-counter anti-inflammatory like ibuprofen helps with the surrounding inflammation, while the burning and tingling itself responds better to a nerve-pain medication like gabapentin or low-dose amitriptyline. Third, an ultrasound-guided corticosteroid injection placed precisely around the nerve to calm the inflammation in the tissue surrounding it.

When is surgery the answer?

When NCS confirms the nerve is compressed and there is a clear space-occupying lesion to remove, or when months of bracing and injections have not quieted the symptoms. The operation, a surgical decompression, opens the fibrous band over the nerve to give it more room and removes any cyst or lesion that is pressing on it.