Tarsal Tunnel Syndrome (TTS) is a condition caused by the compression of the posterior tibial nerve as it passes through a narrow passageway on the inside of the ankle. This compression often leads to burning pain, tingling, and numbness that radiates into the arch and sole of the foot. When symptoms interfere with rest, achieving restorative sleep is difficult, which can slow the body’s natural healing processes. The following strategies offer advice for managing nighttime discomfort to help you sleep better with TTS.
Why Tarsal Tunnel Syndrome Hurts More at Night
TTS symptoms often intensify after lying down because the mechanics of the ankle change during prolonged rest. When the foot is naturally relaxed in bed, it tends to drop and point downward, a position called plantarflexion. This posture shortens the structures within the tarsal tunnel, which increases the compression and tension on the posterior tibial nerve.
Another contributing factor is the redistribution of body fluids while horizontal. When a person is upright, gravity helps drain fluid from the lower extremities, but lying down allows fluid to pool around the ankle. This localized swelling can further constrict the already narrow tarsal tunnel, aggravating the trapped nerve.
Adjusting Sleep Position and Environment
Modifying how you position your foot to keep the ankle in a neutral alignment is essential for better sleep. Sleeping on your back allows for the easiest control over foot position, but requires using pillows or wedges to elevate the ankle. Raising the foot slightly above the level of the heart—often achieved with two or three pillows—promotes fluid drainage and reduces swelling around the nerve.
If you are a side sleeper, avoid resting on the affected side, as this can directly compress the nerve against the mattress. Instead, lie on the unaffected side or your back, placing a pillow between your knees to maintain proper hip and spine alignment. You should also ensure that the weight of your bedding is not pushing your foot into a downward-pointing position, perhaps by using a prop at the foot of the bed or a loosely draped blanket.
Using Braces and Splints for Overnight Support
Specialized supportive devices maintain the ankle in a constant, optimal position throughout the night. Night splints or braces are designed to hold the foot at a 90-degree angle, or in a slight dorsiflexion, preventing the plantarflexion that exacerbates nerve compression. Keeping the ankle joint in this neutral position reduces the tension on the posterior tibial nerve and the surrounding soft tissues.
There are different styles available, including a boot-like plantar splint that covers the calf and foot, or a lighter dorsal splint that runs along the top of the foot and shin. Soft, sock-style braces offer a more flexible option for milder symptoms or for those who find rigid splints uncomfortable. These devices are often adjustable, allowing you or your healthcare provider to fine-tune the stretch angle for maximum comfort and therapeutic benefit. Consistent use of an appropriately fitted night splint provides prolonged relief and is a common part of conservative management for TTS.
Preparing the Foot for Sleep
Reducing inflammation and easing tension before you get into bed can significantly minimize nighttime pain. About an hour before retiring, consider applying a cold pack to the inside of the ankle over the tarsal tunnel for 15 to 20 minutes. The localized cold exposure helps constrict blood vessels, which reduces inflammation and swelling around the compressed nerve.
Performing gentle exercises can also prepare the nerve for a long period of rest. Simple nerve gliding exercises or gentle calf stretches—held for no more than 30 seconds—can help improve the mobility of the tibial nerve without causing irritation. If over-the-counter anti-inflammatory medications are part of your treatment plan, timing the dose to peak around your bedtime can provide sustained pain relief through the night. This proactive preparation helps to calm the irritated nerve before you settle into a static sleep posture.