Tarsal Tunnel Syndrome
Tabassum Ali, DC, CCSP, CCCN
Tarsal tunnel syndrome is tingling and numbness found on the medial arch of the foot from compression on the posterior tibial nerve passing through the tarsal tunnel. The condition presents similar to carpal tunnel syndrome in the wrist and hand, but this time found in the ankle and foot. The tarsal tunnel is found on the medial side of the foot bordered on one side by boney structures and the other by fibrous tissue, which can get inflamed and lead to compression of the nerve. Tarsal tunnel syndrome is associated with the following symptoms:
Pain, burning, tingling on bottom of foot towards heel
The numbness can be attributed to:
Inflammation from a previous fracture
Excessive weight bearing, or
When palpating the foot, you may also inspect for swelling around the medial ankle or a dropped arch of the foot.
Tarsal tunnel syndrome is often differentially diagnosed with plantar fasciitis, or heel spurs, because of similar symptoms. With plantar fasciitis, the patient may be able to pin point the pain on the heel of the foot and will be exacerbated by putting any weight on the foot or excessive duration of exercise. A good way to diagnose tarsal tunnel syndrome is, Tinel’s test; you can tap the tarsal tunnel where the nerve passes through, and if the symptoms are reproduced then it is highly probable. Electrodiaganostic testing or an MRI can help fully diagnose tarsal tunnel syndrome.
Treatment of tarsal tunnel syndrome can vary depending on how chronic the condition is. In rare cases surgery to release the tarsal tunnel can be performed to decrease the pressure on the nerve. If you're considering foot surgery, discuss the benefits and risks with your doctor. Other invasive options include taking a course of anti-inflammatory medications or cortisone injections around the nerve. Conservative treatment is preferred, and can have lasting results if managed properly. Icing the area for no more than 20 minutes every 2 hours can help with the inflammation. Some sources recommend an orthotic to provide support for the medial arch and to relieve pressure on the nerve. The most effective form of treatment would be to address the scar tissue that has built up over time from overuse and adjust any subluxations of the foot and ankle. Once the symptoms have subsided and the scar tissue has healed, the next phase of treatment would be to keep stretching the muscles of the plantar fascia and medial arch of the foot and to strengthen them to prevent future injury.
Warm up of the muscles is important and can be done with simple arch stretching and continued on with the strengthening program. Exercises to strengthen the muscles associated with tarsal tunnel syndrome will include laying a resistance band flat on the ground and scrunching it up with the foot flat on the ground, and simple inversion and eversion with a resistance bands. Approximately 6-8 weeks of treatment will be needed to decrease the pain and strengthen the muscles.
At Lone Star Sport & Spine, we approach injuries in a conservative manner that will give the patient the most weighted benefits. Our providers are board certified chiropractors and certified in full body Active Release Technique. We examine the patient and determine the most efficient and quickest treatment plan for them. Our goal is not only to get the athlete back out on the field doing what they love to do, but to also enhance their athletic performance. We address the scar tissue that is built up from micro tears in the tissue due to overuse or previous injuries and develop a program to strengthen and train the muscles to be used functionally. Most all of our patients find results within a few treatments with decreased pain, and increased range of motion, strength, and balance. We then move into the second phase of treatment with strength and training which is the most important aspect of the treatment, to prevent future injuries.
In summary, to address tarsal tunnel syndrome:
Address the scar tissue in primary involved muscle, and any associated muscle
Adjust any subluxaxtions in the ankle and foot
Strengthen and train the medial arch to prevent future injury (sport specific functional training)
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Edwards, William G., MD, Robert Lincoln, MD, Frank G. Bassett, MD, and J. Leonard Goldner, MD. "The Tarsal Tunnel Syndrome Diagnosis and Treatment." The Journal of the American Medical Association. JAMA, 27 Jan. 1969. Web. 31 Mar. 2013. <
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