Tarsal Tunnel Syndrome (TTS) results from the compression of the posterior tibial nerve as it travels through the tarsal tunnel, a narrow passageway on the inside of the ankle. The tunnel is formed by ankle bones and ligaments. Pressure on the nerve produces symptoms characteristic of nerve pain, including shooting pain, numbness, or a burning sensation that typically affects the sole of the foot and toes. Symptoms can appear suddenly or be aggravated by activities like prolonged standing or exercise. Addressing this nerve entrapment requires a progressive approach, starting with immediate self-care before moving to professionally managed non-surgical or, if necessary, surgical treatments.
Immediate Relief Through Self-Care
Initial management focuses on reducing inflammation and strain on the entrapped nerve through at-home measures. Limiting weight-bearing activities and resting the foot and ankle is the first step to prevent further irritation of the tibial nerve. This rest should be accompanied by cryotherapy, using an ice pack on the painful area for cycles of 10 to 20 minutes a few times daily to minimize local swelling.
Compression and elevation are helpful components of self-care, controlling swelling that may contribute to nerve compression. Elevating the foot above the level of the heart, especially when resting, assists in draining excess fluid from the lower extremity. Supportive elastic bandages or a brace can provide gentle compression to the ankle area, though care must be taken not to apply excessive pressure that could worsen the nerve symptoms.
Footwear should be evaluated and changed, focusing on shoes that provide adequate support and room. Footwear that is too tight or lacks proper arch support can exacerbate the strain on the tibial nerve, making it important to avoid high heels or narrow shoes. Over-the-counter Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), such as ibuprofen or naproxen, can be taken temporarily to manage pain and reduce inflammation. These techniques are intended for temporary relief and should not replace consultation with a healthcare professional for a complete diagnosis and long-term treatment plan.
Medically Managed Non-Surgical Treatments
When self-care measures are insufficient, medical professionals initiate non-surgical treatments aimed at stabilizing the foot and reducing mechanical pressure on the nerve. Physical therapy (PT) is often prescribed, focusing on specific exercises designed to improve the flexibility and mobility of the ankle and foot. A specific technique used in PT is nerve gliding, which involves gentle movements intended to help the tibial nerve slide more freely within the tunnel, reducing friction and irritation.
Specialized bracing and custom orthotics are used, particularly if TTS is related to biomechanical issues like flat feet or excessive pronation. Custom-fitted arch supports or inserts work to correct the alignment of the foot, reducing the abnormal stretching or pressure placed on the nerve. A doctor may also recommend a night splint or walking boot to maintain the foot in a neutral position during sleep or for temporary immobilization to reduce nerve traction.
For localized inflammation, a physician may administer a corticosteroid injection directly into the tarsal tunnel. The steroid medication works as a powerful anti-inflammatory agent, decreasing the swelling around the nerve and offering a period of symptom relief. This treatment is not a long-term solution, and due to the temporary nature of the relief and potential side effects, injections are used judiciously.
If pain persists despite these physical and localized interventions, a physician may prescribe oral medications that specifically target nerve pain. Drugs such as gabapentin or pregabalin work by calming the overactive pain signals sent by the damaged nerve. These prescription medications are considered when over-the-counter pain relievers fail to provide adequate relief for chronic neuropathic symptoms.
Surgical Intervention and Recovery
Surgery is reserved for individuals whose symptoms have not improved after six months or more of non-surgical treatment, or when a structural mass like a cyst or tumor is compressing the nerve. The procedure is Tarsal Tunnel Release, or tibial nerve decompression. The surgeon makes an incision along the inner ankle to access the tarsal tunnel and cuts the flexor retinaculum, the ligament forming the roof of the tunnel.
Releasing this ligament creates more space within the tunnel, immediately relieving the compressive pressure on the tibial nerve and its branches. In some cases, the surgeon will also address any other structures, such as scar tissue or bone spurs, that might be contributing to the compression. The procedure is often performed on an outpatient basis, aiming to prevent permanent nerve damage resulting from chronic compression.
Post-operative recovery involves a structured timeline to ensure proper healing and nerve function restoration. Initially, patients may be non-weight bearing for about one to two weeks, often utilizing a splint or surgical shoe. Following this period, a transition to full walking activity can begin, with a gradual return to higher-impact activities like running typically occurring around six weeks after the surgery. While some patients experience immediate relief, full nerve recovery is a gradual process, sometimes taking six to eighteen months depending on the extent of prior nerve damage.