Mir Neurology & Spine Center

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Tarsal Tunnel Syndrome (NCS)

What is Tarsal Tunnel Syndrome?

Tarsal Tunnel is located on the inside of the ankle and is made by the band of ligaments and the ankle bones. The tarsal tunnel is a passageway for many nerves, blood vessels, and tendons which are responsible for the movement and flexibility of feet. Tarsal Tunnel Syndrome(TTS) is a condition that is caused when a posterior tibial nerve is compressed. The posterior tibial nerve passes through the tarsal tunnel. This can cause tingling, pain, and numbness in the foot.

Some people describe the “Pins and Needles” sensation on the bottom of their feet. Those suffering from Peripheral Neuropathy have similar symptoms.

Inflammation or swelling can occur within this tunnel for a number of reasons. The laciniate ligament has a limited ability to stretch, so increased pressure will eventually cause compression on the nerve within the tunnel. As pressure increases on the nerves, the blood flow decreases. Which in turn makes the nerves respond with altered sensations like tingling and numbness. Fluid can collect in the foot when standing and walking and this makes the condition worse.

What causes TTS?

Excessive pressure on the “posterior tibial nerve” that passes through the “Tarsal Tunnel” is the source of the pain because the blood circulation to the tissues in the foot and toes is restricted. The situations include:

  • Induced swelling in reaction to an ankle sprain
  • Fallen arches or fallen feet
  • Swollen tendon, varicose vein, bone spur, or ganglion cyst
  • Other diseases such as diabetes or arthritis can lead to nerve compression and cause swelling

TTS Symptoms

Patients complain typically of:

  • Numbness in the foot radiating to the big toe and the first 3 toes
  • Pain, burning, electrical sensations, and tingling over the base of the foot and the heel
  • Tingling in your toes and numbness on the sole of your foot is a common symptom
  • Cramping feeling in the foot

TTS Diagnosis

Confirming whether a patient has Tarsal Tunnel Syndrome usually requires performing specific tests of nerve function. Nerve Conduction Studies (NCS) and Electromyography (EMG) testing are procedures that evaluate how well the nerves of the wrist carry electrical signals. This information can help determine the extent of nerve damage (if any) and how best to treat the condition. The diagnosis will involve:

  • A detailed clinical examination
  • Complete medical history
  • CT scan or MRI
  • EMG or nerve conduction study

TTS Treatment

Treatment for this condition depends on what is contributing to the pressure on the nerve.

  • Anti-inflammatory Medication: Anti-inflammatory medication and rest may be suggested to control the symptoms initially. Anti-inflammatory medications help reduce the inflammation and swelling of the tissues around the tibial nerve in the tarsal tunnel and may ease the irritation on the nerve

  • Cortisone Injection: A cortisone injection may give temporary relief of symptoms. The cortisone is injected into the tarsal tunnel so that it bathes the nerve and other tissues. This may decrease the inflammation and swelling of the tissues in the tarsal tunnel and reduce the swelling on the nerve. Your Podiatrist may suggest specialized inserts, called orthotics, for your shoes. If your tarsal tunnel syndrome is being aggravated by an abnormal position of the foot such as pronation, orthotics may be suggested to relieve the problem.

  • Surgery:  If your symptoms fail to respond to nonsurgical treatments, surgery to relieve the pressure on the tibial nerve may be suggested. The surgeon then makes a small incision in the skin behind the inside ankle bone. The nerve is located and released by cutting the laciniate ligament. The surgeon will then surgically follow the nerve into the foot, making sure the nerve is free of pressure throughout its course. The laciniate ligament is left open to give the nerves more space. This surgery can usually be done on an outpatient basis, meaning you can leave the hospital the same day.

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