Tarsal Tunnel Syndrome (TTS) occurs when the posterior tibial nerve is compressed within the tarsal tunnel, a narrow passage in the ankle. This tunnel is formed by ankle bones and the overlying flexor retinaculum, a thick band of ligament. Finding the appropriate medical specialist is important for accurate diagnosis and the creation of an effective treatment plan for this nerve entrapment. A multidisciplinary approach is often necessary to alleviate symptoms and prevent potential long-term nerve damage.
What Tarsal Tunnel Syndrome Is
The tarsal tunnel is located on the inside of the ankle, allowing passage for the posterior tibial nerve, tendons, and blood vessels into the foot. When the space within this tunnel narrows, it puts pressure on the tibial nerve, a condition analogous to carpal tunnel syndrome in the wrist. This compression can lead to uncomfortable symptoms, most commonly pain, tingling, and numbness, often described as a burning sensation. These symptoms typically radiate along the bottom of the foot and into the toes, potentially worsening during or after physical activity.
The causes of Tarsal Tunnel Syndrome are varied, typically involving any factor that reduces the available space within the tunnel or increases tension on the nerve. Common mechanical causes include structural issues like fallen arches or severely flat feet, which create excessive strain on the nerve. Trauma such as an ankle sprain or fracture can cause swelling that compresses the nerve, while inflammatory conditions like arthritis or diabetes can also lead to nerve damage. Less common causes involve space-occupying masses, such as ganglion cysts, bone spurs, or enlarged varicose veins.
Specialized Medical Professionals Involved
Podiatrists
Podiatrists are often the initial point of contact for patients experiencing foot and ankle pain, including TTS. They specialize in the diagnosis and conservative management of foot mechanics, frequently prescribing custom orthotic devices to correct underlying structural issues like overpronation. Podiatrists are skilled in diagnostic procedures, including the clinical Tinel’s test, and can initiate non-surgical treatments like corticosteroid injections to reduce local inflammation and swelling around the nerve.
Orthopedic Surgeons
Orthopedic surgeons specializing in the foot and ankle manage the full spectrum of TTS, from initial conservative treatment to surgical intervention. They oversee the overall treatment strategy, particularly if the cause is related to a musculoskeletal issue, such as a bone spur or a chronic structural deformity. When non-surgical methods fail to provide adequate relief, the orthopedic surgeon performs the definitive Tarsal Tunnel Release procedure.
Neurologists
Neurologists are experts in the nervous system and play a focused role, primarily in confirming the diagnosis and assessing the severity of the nerve damage. They perform electrodiagnostic testing, such as Nerve Conduction Velocity (NCV) studies and electromyography (EMG), which measure the speed and strength of electrical signals through the tibial nerve. These objective tests are instrumental in differentiating TTS from other conditions that might mimic its symptoms, such as nerve compression originating in the lower back.
Physical Therapists (PTs)
Physical therapists (PTs) are crucial members of the care team, focusing on rehabilitation and functional recovery. Their role involves developing targeted exercise programs to improve the flexibility of the ankle and foot structures. They also work on strengthening the muscles that support the arch and stabilize the foot, which helps to reduce mechanical stress on the tibial nerve.
Non-Surgical and Surgical Treatment Options
Conservative management is the preferred initial approach for TTS, aiming to reduce inflammation and relieve pressure on the compressed nerve. This often begins with simple measures like rest, applying ice to the affected area, and using non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and swelling. Immobilization with a brace or splint may also be recommended to limit movement and allow the inflamed nerve to recover.
A cornerstone of non-surgical treatment involves the use of custom orthotic inserts, which are designed to support the foot’s arch and correct abnormal gait mechanics. These devices minimize excessive motion, such as overpronation, that can stretch or compress the tibial nerve. Corticosteroid injections deliver a potent anti-inflammatory medication directly into the tarsal tunnel, offering significant, though often temporary, relief from acute swelling and pain.
Physical therapy utilizes various modalities, including stretching exercises for the calf and foot, alongside strengthening routines for the intrinsic foot muscles. These sessions are designed to restore a normal range of motion and build stability, which helps prevent future nerve irritation. Nerve gliding exercises are also incorporated to encourage the tibial nerve to move smoothly within the tunnel.
When conservative measures have been exhausted or if a space-occupying lesion is the confirmed cause, surgical intervention becomes the next step. The procedure, known as Tarsal Tunnel Release or neurolysis, is performed to decompress the posterior tibial nerve. The surgeon makes an incision along the inner ankle to cut and release the flexor retinaculum, the ligament forming the roof of the tunnel. This release immediately creates more space, reducing the pressure on the nerve and providing long-term relief from chronic pain and numbness.