What is Tarsal Tunnel Syndrome?

Tarsal Tunnel Syndrome (TTS) is known as a compression neuropathy (nerve disorder due to squeezing of the nerve) in the ankle and foot. It is similar to Carpal Tunnel Syndrome, which occurs in your wrist, however far less common. In Latin, 'tarsal' means ankle, therefore Tarsal Tunnel Syndrome results from compression or damage to the posterior tibial nerve located in your tarsal canal, which runs through the small space along the inside of your ankle into the heel and sole of your foot. It causes a lot of pain in your foot, ankle and toes. This condition is slowly progressive and occurs more commonly after 30 - 40 years of age.

Often damage to your posterior tibial nerve in one location may affect the overall functioning of your nerve, so you are more at risk of suffering from compression in other areas along the nerve. The nerve sends signals along its length and also moves its own nutrients, which is necessary for optimal function. Nutrients move along the entire length of your nerve via axoplasms (jelly-like material that fills the cells of the axons). If the flow of these nutrients is blocked, your nerve tissue further from the area of compression does not receive the essential nutrients to fight off injuries, and your damage will get worse.

Other names and/or similar conditions:

• Tarsal Tunnel Neuropathy
• Entrapment Neuropathy Of The Tibial Nerve
• Posterior Tibial Neuropathy
• Compression Of The Tibial Nerve
• Posterior Tibial Neuralgia

Tarsal Tunnel Syndrome Anatomy

The tarsal tunnel is found between the thick, overlying fibrous tissue on one side of your foot and the underlying bones on your other side. The flexor retinaculum acts as the top of your tarsal tunnel. It forms a deep, band of fibrous connective tissue that surrounds the muscles and nerves in your lower leg and ankle. The top of the Calcaneus (largest tarsal bone that makes up the heel), the inner wall of the Talus (2nd largest tarsal bone that forms the ankle joint connecting the leg bones to the foot bones) and the inner/bottom part of the Tibia (shinbone) comprise the bottom of your tarsal tunnel. Your ankle and foot tendons, muscles, nerve, artery and vein pass through the Tarsal Tunnel to get to the bottom of your foot.

Your Posterior Tibial Nerve is found between the Posterior Tibial Muscle, the Flexor Digitorum Longus and the Flexor Hallucis Longus muscles in your lower leg/ankle. The Tibial Nerve moves behind the bump on the inside of your ankle (Medial Malleolus) and through the Tarsal Tunnel, where it then divides into nerve branches in the sole of your foot.

Symptoms of Tarsal Tunnel Syndrome

Although they vary from person to person, most of these symptoms are generally experienced on either the inside of the ankle and/or the bottom of the foot. The most common symptoms noted by those who suffer from Tarsal Tunnel Syndrome are:

• Tingling, burning, or prickling sensation (also known as paresthesias), in your foot (often in your arch, toe or heal).
• Vague or sharp pain, near the area where the nerve is squeezed (often in the sole of your foot, near your big toe, or along your nerve); this pain tends to be worse at night.
• Numbness, a loss of sensation in the area of skin that is supplied by the nerve.
• Atrophied (weakened) muscles in your inner foot (around the ball or arch of your foot) can affect your gait (the way you walk). You may have a tendency to overpronate (your foot rolls in too much), limp or feel uncoordinated as a result of too much pressure being placed on your foot.
• A lower foot deformity (like flat feet) can increase tension in the foot and may instigate the symptoms of TTS.

If left untreated, you are at risk of suffering from permanent nerve damage.

When treating Tarsal Tunnel Syndrome, rest the area as much as possible, apply ice for 10-20 minutes at a time for at least 3 times a day. Do this to the injured area for the first day to 3 days. If you have a cold / hot pack for the ankle and bottom of the foot, you will quickly find that frequent hot/cold treatments for these areas are much less troublesome, and you can do this while getting on with your day. Utilizing pack wrap is helpful in securing the packs to these areas. Note that the importance of the hot / cold treatment is very high, though when surveyed, most TTS sufferers never take advantage of this easy treatment step. Moist heat may be used after acute swelling of the ankle and foot has improved and rest prevents further progression of the injury. Ice will reduce initial inflammation and swelling and the moist heat circulates blood through the area to speed the healing process. This can be further helped by the use of ultrasound applications over the affected area, as it reduces swelling quickly and increases blood flow to the area.

The long term use of therapeutic ultrasound is common with this injury, as the application of ultrasound will:

Counteract atrophy in muscles and tendons.

Increase the elasticity of all tendons that pass through the tarsal tunnel.

Soften inelastic scar tissue from injured tendons / muscle fiber to the point where it is eventually re-absorbed by the body.

Decrease inflammation of tendons, and the flexor retinaculum (a fibrous sheath passing through the tarsal tunnel). All tendons in the tarsal tunnel are sheathed, and once tendons become inflamed, the sheath swells and can also become inflamed, and at the worst, infected. If you suspect you have any type of infection in the area, please consult a physician immediately as this can be very damaging if left untreated. (Never use ultrasound over anything suspected of being infected.)

Changes in footwear and orthotic arch supports, along with calf and foot stretching exercises have also been known to provide relief for individuals with chronic TTS.

A Final Word About Therapeutic Ultrasound

It is important to know that therapeutic ultrasound will alleviate TTS symptoms, but to truly treat TTS properly and prevent reoccurrence, an extended treatment term is required - 2 months is not unusual. Treatment length will vary depending on the severity, and there are some cases of TTS that are just too chronic, in which case there are very few treatment options other than invasive surgery. If this is the case for your TTS condition, please make sure you are fully informed about the risks and rewards of TTS corrective surgery.

An Inferno Wrap Therapy Device is a very helpful tool for an injured tendon. Through the absorption of radiant energy, tissues are safely and gently heated - increasing blood flow within the treated area. Your body's natural response to this increased temperature is to try to maintain a condition of homeostasis - a balanced environment or state of equilibrium throughout the body. To do this, your body responds with a rapid increase in blood flow to the area (this is known as vasodilation), increasing the supply of nutrients to injured cells and flushing out toxins (including lactic acid, commonly found in trigger points) to promote healing. Our Inferno Wrap Pain Relief Device provides effective, non-invasive, non-addictive pain relief with no side effects.

If you suffer from mild inflammation or pain after certain activities or movements use ultrasound therapy when you complete the activity and then rest and elevate your area of injury. Limit the application of ultrasound to a couple of treatments per day (the manual will recommend treatment frequency depending upon the injury). In between ultrasound treatments, maximize your pain relief and injury recovery by using the Inferno Wrap Therapy Device. When you're on the go, and not near an electrical outlet, take advantage of our Freezie Wrap cold wraps - the highest rated wraps in the industry. Proven Performance, Proven Relief - only found at MendMeShop.com. If you have been given a treatment plan by your health professional, make sure you adhere to it to ensure pain free living. In general, people who are committed to their therapies and exercises will have the best medical outcomes.