Tarsal Tunnel Syndrome

Disclaimer: While the information on this web site has been helpful to many people, you should check with your medical doctor or other health care professional in deciding what is the best course of action to take for your situation. This information is designed to help you be a better partner in your care, and not as a do-it-yourself guide to diagnosing and/or treating your health care issue.


What is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is a condition in which the tibial nerve is compressed in the bony/ligamentous tunnel that it runs through on the inside of the ankle. The tibial nerve sends sensory information from the heel and sole of the foot to up to the spinal cord and brain. When the tibial nerve is compressed and/or inflamed in the tarsal tunnel then the person may feel aching, pressure, tingling and/or numbness in the heel and/or sole of the foot.


What Causes Tarsal Tunnel Syndrome?

The tibial nerve can become compressed in the tarsal tunnel by thickening of the tendons of the muscles that share the tunnel space with the nerve. This thickening can be caused by tendonitis and/or by overuse of the muscles (often by excessive pronation of the foot during running.

The tarsal tunnel can become a tight corridor due to excess fluid in the person’s body generally, or a local injury, ganglion, arthritis or many other factors. Some people develop it due to poor footwear!

You should see your doctor if you think you have tarsal tunnel syndrome for a medical diagnosis and possible treatment.


Testing in Tarsal Tunnel Syndrome

There are common physical tests for carpal tunnel syndrome. In the Dorsiflexion Eversion Test the examiner flexes the ankle backward (dorsiflexion) and everts the ankle (turns the ankle outward). When the ankle is dorsiflexed the tibial nerve is placed on stretch in the area of the tarsal tunnel. At the same time the eversion movement tenses the flexor retinaculum. These two physical challenges – stretching the nerve and compressing it – often create or worsen the pain of tarsal tunnel syndrome.

Other physical tests include tapping or strumming the nerve to determine if it is irritated. Medical evaluation may include ultrasound or nerve conduction testing. If the nerve is severely damaged and/or getting worse then surgery may be the best option.

However, many people attempt to deal with the problem non-surgically and only proceed with surgery if the symptoms are becoming progressively worse with conservative care. The information on this page is to help people with conservative care.

Many different hands on practitioners may be helpful ranging from physiotherapists, chiropractors, osteopaths and massage therapists. Since I am a massage therapist, my self care suggestions are shaped by my training and my experiences with clients.


Hands On Treatment for Tarsal Tunnel Syndrome

The following techniques may be helpful in reducing symptoms of tarsal tunnel syndrome. They may be in the order below, or in a different order with different emphasis depending on the clinical situation.

1. Milking fluid from the tarsal tunnel

2. Releasing the flexor retinaculum

3. Milking fluid from the ankle joint

4. Milking fluid from within the tibial nerve

5. Releasing the abductor hallucis muscle

6. Neural sliding and gliding of the tibial nerve relative to the flexor retinaculum

7. Stretching the tibial nerve at the tarsal tunnel to release adhesions within the nerve.

The You Tube video below demonstrates some of the key interventions in lessening tarsal tunnel syndrome.

In this You Tube video clip the Abductor Hallucis muscle, which overlies the tibial nerve, is released and lengthened to decompress the tibial nerve.


Tarsal Tunnel Home Care

Clients with tarsal tunnel syndrome may need to address the following issues.

1. Chronic inflammation/swelling in the feet with better supporting footwear and cool or cold foot baths

2. Chronic foot pronation with orthotics

3. Weak arches with the short foot exercise.

Sometimes tarsal tunnel syndromes come from nerve compression or irritation further up the leg, as far as the hip or low back. Your health care professional can help determine if this is the case.


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