Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is a cause of foot pain. There are conservative treatment options available.

What is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome (TTS), or posterior tibial neuralgia, occurs when the tibial nerve (responsible for sensation in the bottom of the foot) is compressed. The tarsal tunnel of the foot has tendons, nerves, and arteries, which allow the foot to be flexible. Tarsal tunnel syndrome can be caused by disease, injury, or just the natural shape of the foot, such as having fallen arches or flat feet. Ankle sprain, bone spurs, varicose veins, arthritis, and diabetes can also cause inflammation that compresses the nerves. The symptoms of TTS include numbness, tingling sensation, burning sensation, and shooting pain.¹ Numbness generally affects the first three toes and big toe. The base of the foot and the heel may tingle. Patients often experience electrical sensations, pain, and burning. If there is a lot of entrapment, the whole foot can be affected. In those situations, ankle pain occurs. Nerves tingle and feel numb because blood flow decreases. The situation worsens as fluid starts to collect in the foot, due to walking and standing. Muscles can cramp from the loss of nerve supply. Pins and needles, neuropathy, hot and cold sensations, pain that radiates to the knee, and foot swelling are other symptoms.² Diagnosis of tarsal tunnel syndrome can be done via medical history and exam, X-ray/MRI or other scans, and electrical testing, such as EMG.³ Ultrasound is another diagnostic tool. A “positive Tinel’s sign” is another part of diagnosis. Tinel’s sign is a sensation like a “tingling electrical shock…when you tap over an affected nerve”. This may be felt in both the foot and inner leg.⁴

Standard Treatment Options

Anti-inflammatory medications and steroid injections are often prescribed for TTS. Orthotic devices (i.e., splints, braces) may also be recommended. The goal is to reduce inflammation and pressure on the nerve. In severe cases, tarsal tunnel release surgery would be an option.⁵ Other treatment methods include manipulation, rest, casting, wrapping, compression hose, and even Lidocaine patches. Surgery is a last option, as infection, bleeding, and “unpredictable healing” could result. Surgical recovery can take a year, but some patients may not experience relief even with surgery.⁶

Chiropractic for TTS

Chiropractic care is a conservative treatment approach for patients experiencing the symptoms of TTS. Cryotherapy, or using ice water immersion, is one treatment method that can be used. Inferential current therapy may also be helpful.⁷ In a case study, a 51 year old man with several years of “intermittent numbness in his left foot” received chiropractic treatment for this TTS. The treatments used were “mobilization of the ankle”, as well as underwater ultrasound and electrical muscle stimulation (EMS). Additionally, manual therapy and arch support taping were applied. The chiropractic treatment included orthotics and ankle exercises. The patient had a positive response after 3 sessions.⁸ Other chiropractic therapies that can help TTS include strengthening, soft tissue manipulation, massage, and fascial stripping.⁹