Tarsal Tunnel Syndrome (TTS) occurs when the posterior tibial nerve, located in a narrow passage on the inside of the ankle, becomes compressed. This compression, often caused by factors like fallen arches, ankle sprains, or systemic conditions such as diabetes, leads to symptoms like pain, tingling, burning, or numbness in the sole of the foot and toes. Treatment involves a tiered approach, starting with self-care and progressing to professional non-surgical or surgical interventions. The goal is to relieve pressure on the nerve, restore function, and prevent symptom recurrence.
Immediate Non-Invasive Relief Strategies
Initial management focuses on reducing inflammation and easing pressure on the affected nerve. The R.I.C.E. protocol (Rest, Ice, Compression, and Elevation) provides a foundation for home care. Avoiding activities that trigger pain, such as prolonged standing or running, allows the irritated nerve time to settle.
Applying ice to the inside of the ankle for 10 to 20 minutes helps decrease localized swelling. Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) like ibuprofen can also temporarily reduce pain and inflammation.
Footwear choices are also important for self-management. Opting for non-constrictive shoes that provide robust arch support helps stabilize the foot and reduce stress on the posterior tibial nerve. For those with flat feet or overpronation, off-the-shelf arch supports or heel wedges can improve foot positioning.
Professional Conservative Treatments
When self-care measures fail to provide lasting relief, professional medical intervention is necessary. Healthcare providers often prescribe customized orthotics, which are inserts molded to the patient’s foot to correct biomechanical issues like excessive pronation. These devices redistribute pressure and maintain optimal alignment, reducing mechanical stress on the tibial nerve.
Physical therapy is a central component of non-surgical treatment, typically involving a program of exercises and modalities. Therapists utilize techniques like nerve gliding exercises, which are gentle movements designed to mobilize the compressed nerve. Stretching exercises targeting the calf muscles and plantar fascia are also employed to reduce overall tension.
If inflammation is a significant barrier, a physician may administer a corticosteroid injection directly into the tarsal tunnel. This powerful anti-inflammatory medication quickly reduces swelling around the nerve, temporarily relieving pressure and symptoms. While effective for relief, injections do not correct the underlying cause of compression.
Surgical Intervention and Decompression
Surgery is the final option, reserved for chronic or severe cases where conservative treatment has failed for six to twelve months. The primary procedure is Tarsal Tunnel Release, or Decompression, which aims to definitively relieve pressure on the posterior tibial nerve. The surgeon makes an incision along the inside of the ankle to access the tarsal tunnel.
The surgeon identifies and cuts the flexor retinaculum, the thick ligament forming the roof of the tunnel. Dividing this ligament creates more space, immediately decompressing the tibial nerve and its branches. Any space-occupying lesions, such as cysts or scar tissue, are also removed to ensure a complete release.
Post-Treatment Rehabilitation and Recurrence Prevention
Following successful treatment, a structured rehabilitation program is implemented to maintain relief and prevent recurrence. For surgical patients, recovery involves a period of non-weight-bearing followed by a gradual return to activity, with full recovery sometimes taking several months. Physical therapy focuses on strengthening foot and ankle muscles, particularly the posterior tibialis, to improve stability and arch support.
Long-term management emphasizes maintaining strength and flexibility through a consistent home exercise program. This includes regular calf and foot stretching to reduce tension that could re-compress the nerve. Permanently wearing supportive footwear and custom orthotics, if prescribed, is often necessary to control foot mechanics and minimize strain.
Addressing underlying medical conditions, such as diabetes or arthritis, is also important for recurrence prevention. Maintaining a healthy weight and ensuring proper biomechanical support significantly reduces the risk of the posterior tibial nerve becoming entrapped again.