Tarsal Tunnel Syndrome (TTS) occurs when the posterior tibial nerve, which runs down the leg to the foot, becomes compressed within the tarsal tunnel on the inside of the ankle. This narrow passageway is formed by ankle bones and a band of ligaments. Swelling or structural changes can put pressure on the nerve, causing compression. Symptoms typically include a burning sensation, numbness, or tingling, often felt along the bottom of the foot and toes. Management begins with simple adjustments before escalating to professional medical care.
Immediate Self-Management and Conservative Adjustments
Initial management involves reducing mechanical strain on the nerve and controlling inflammation contributing to compression. Activity modification is a primary measure, requiring temporarily reducing or stopping repetitive activities that aggravate the ankle, such as prolonged standing or running. Allowing the foot adequate rest promotes healing.
Applying the RICE principle is an effective starting point for symptom relief. Use ice packs on the inner ankle for 10 to 20 minutes several times a day to decrease localized swelling and pain. Compression and support, provided through an elastic bandage or brace, help stabilize the foot and minimize inflammation. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also be used to temporarily reduce pain and inflammation surrounding the nerve.
Patients should choose supportive, non-constricting shoes, avoiding options that place direct pressure on the inner ankle. Over-the-counter arch supports or heel wedges can help reduce tension on the tibial nerve. These devices minimize excessive foot movement, such as pronation, stabilizing the condition before consulting a specialist.
Professional Non-Surgical Medical Interventions
If self-management techniques do not alleviate symptoms, a healthcare professional will typically recommend focused non-surgical treatments aimed at reducing nerve pressure and improving function. Physical therapy is often included, focusing on specific stretching routines for the calf muscles and ankles to reduce tension on surrounding tissues. Therapists may also employ nerve gliding exercises, which are gentle movements designed to mobilize the tibial nerve and prevent it from becoming restricted.
For pain that is not managed by over-the-counter options, a physician may prescribe stronger anti-inflammatory medications, sometimes in topical form, or nerve-specific medications, such as gabapentin, to manage the neuropathic symptoms. A common intervention is a corticosteroid injection, delivered directly into the tarsal tunnel area. These injections are intended to reduce swelling around the nerve, offering temporary relief and potentially breaking the cycle of inflammation.
The doctor may prescribe custom-made orthotics, which are distinct from generic supports. These devices are molded specifically to the patient’s foot, allowing for precise correction of biomechanical issues like excessive pronation or flat feet that strain the nerve. Custom orthotics help maintain the foot’s proper arch and alignment, reducing movements that cause compression on the tibial nerve.
Surgical Treatment Options
If symptoms are severe, persistent, or fail to respond adequately to conservative non-surgical management, a surgeon may recommend Tarsal Tunnel Release, or nerve decompression. This operation is also considered when imaging identifies a space-occupying lesion, like a bone spur or cyst, that is compressing the nerve. The goal of the surgery is to physically relieve pressure on the tibial nerve and its branches.
The procedure involves the surgeon making an incision along the inner ankle that extends toward the arch of the foot. The flexor retinaculum, the ligament forming the roof of the tarsal tunnel, is carefully cut to enlarge the tunnel and create more space for the nerve. This action immediately decompresses the tibial nerve. The surgeon may also examine the nerve’s distal branches to ensure all compressed areas are released.
Tarsal Tunnel Release is often performed as an outpatient procedure, allowing the patient to return home the same day. Post-operatively, the ankle is placed in a splint or protective boot. Patients are advised to limit weight-bearing or avoid it entirely for the first two to three weeks. Physical therapy is necessary to restore strength and mobility to the foot and ankle, with a full return to high-impact activities potentially taking several months.