The Center for Podiatric Care and Sports Medicine

Tarsal Tunnel Syndrome: Help, Help, I’m Being Compressed!

Posted by on Friday, August 2nd, 2013


Nerves can be very fussy and very sensitive. They like to have plenty of room surrounding them and they certainly don’t like to be pinched. Unfortunately, inflammation of surrounding tissue can crowd the space of our sensitive nerve friends and cause devastating pain to the sufferer. Tarsal Tunnel Syndrome (TTS) causes may include a traumatic foot injury, repeated foot injuries, ankle sprains, diseases like arthritis or diabetes, ganglion cysts, bone spurs, swollen tendons, or having naturally flat feet / fallen arches. You don’t need to be repressed by nerve compression. In this article, we’ll give you some tips for managing the pain and speeding toward recovery.

What Is Tarsal Tunnel Syndrome?

The tarsal tunnel is the canal between the medial malleolus (the bump on the inside of the ankle) and the flexor retinaculum (a band of ligaments that stretch across the foot). Nerves, arteries and tendons reside in the tarsal tunnel and add flexibility to the foot. When the tibial nerve that provides sensation to the bottom of the foot is compressed, you have this not-so-wonderful condition known as Tarsal Tunnel Syndrome (or, as it’s also called, posterior tibial neuralsia.)

Tarsal Tunnel Syndrome Symptoms

Symptoms of tarsal tunnel syndrome (TTS) may include some of all of the following:

  • Pain and tingling in around the ankles (and sometimes the toes)
  • Redness and swelling of the feet
  • Hot and cold sensations in the feet
  • Painful burning, tingling or numbness (especially during activity or after standing for long periods)
  • Electric shock sensations
  • Pain radiating to the toes, ankles and leg
  • Burning sensation on the bottom of the foot
  • “Pins and needles” feeling in the feet

Tarsal Tunnel Syndrome: Diagnosis & Treatment

Neurologists, nerve specialists and podiatrists will give you a comprehensive clinical exam, take an x-ray/CT scan/MRI, and perform a nerv conduction study or EMG. From there, conservative treatments will be explored first.

Treatment for Tarsal Tunnel Syndrome may include:

  • Anti-inflammatory medication (Anaprox, Ultracet, Neurontin, Lyrica, Lidocaine patches)
  • Corticosteroid injections
  • Walking boots, braces, splints or orthotics
  • Hot wax baths
  • Wrapping
  • Compression hose

Surgery for Tarsal Tunnel Syndrome

Surgery is seen as a last resort. A 1996 review of literature found that success rates for Tarsal Tunnel Syndrome surgery ranged from 44% to 100%. During surgery, an incision is made behind the ankle bone and down toward the bottom of the foot. The posterior tibial nerve is then separated from the artery and vein, followed down to where the nerves can be released. Cysts or other underlying problems can also be corrected. Scarring of the nerve or branches can be treated with neurolysis. A bulky cotton wrap then immobilizes the joint for the next three weeks. As with all surgeries, there is always risk of bleeding, infection or poor healing. Your doctor will work with you to find the best treatment for you, specifically, so you don’t have to suffer with nerve compression pain.


If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.