■ ■ ■ Description

Tarsal tunnel syndrome is a nerve disorder of the foot and ankle that causes pain and occasionally loss of feeling in the bottom of the front of the foot (by the ball of the foot). It involves compression of the posterior tibial nerve at the inner ankle by ligament-like tissues (retinaculum), bony prominences, cysts, or benign or malignant tumors (rare).

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■ ■ ■ Common Signs and Symptoms

• Tingling, numbness, or burning from the arch of the foot and traveling to the bottom of the forefoot

• Diffuse, poorly localized pain and tenderness that may be felt behind the inner ankle and the bottom of the foot; worse with activity and better with rest

• Occasionally, pain at night in bed

• A feeling of the ankle giving way

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■ ■ ■ Causes

Pressure on the posterior tibial nerve behind the inner ankle caused by ligament-like tissue (retinaculum) that covers and does not stretch when the nerve is pushed on by bony prominences, inflamed tendons, cysts, or benign or malignant (very rare) tumors, resulting in compression of the nerve

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■ ■ ■ Risk Increases With

• Looseness of the joints of the foot and flat feet

• Arthritis of the ankle

• Tendinitis of the foot and ankle muscles

• Previous foot or ankle injury including sprains and fractures

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■ ■ ■ Preventive Measures

• Maintain appropriate conditioning:

  • Foot and ankle flexibility

  • Muscle strength and endurance

  • Cardiovascular fitness

• Wear proper shoes and arch supports (orthotic).

• Taping, protective strapping, bracing, or high-top tennis shoes may help prevent ankle sprains and nerve stretching injury.

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■ ■ ■ Expected Outcome

• This condition is usually curable with appropriate treatment, and sometimes it heals spontaneously. Occasionally, surgery is necessary.

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■ ■ ■ Possible Complications

• Permanent numbness, persistent pain in the foot or ankle, and inability to compete due to pain

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■ ■ ■ General Treatment Conditions

Initial treatment consists of rest from the offending activity and medications and ice to help reduce pain and inflammation. Arch supports and heel wedges for the inner heel may provide relief. Cross-training may be of benefit. A short period of casting or bracing may also help reduce inflammation around the nerve. Stretching and strengthening exercises of the muscles of the foot and ankle may be useful. If this treatment is not successful, and particularly if a cyst or tumor-like mass is pressing on the nerve, surgery may be required to free the pinched nerve. This often provides almost complete relief, with full return to sporting activities.

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■ ■ ■ Medication

• Nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen (do not take within 7 days before surgery), or other minor pain relievers, such as acetaminophen, are often recommended. Take these as directed by your physician. Contact your physician immediately if any bleeding, stomach upset, or signs of an allergic reaction occur.

• Pain relievers may be prescribed as necessary by your physician, usually only after surgery. Use only as directed and only as much as you need.

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■ ■ ■ Heat and Cold 

• Cold is used to relieve pain and reduce inflammation for acute and chronic cases. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

• Heat may be used before performing stretching and strengthening activities prescribed by your physician, physical therapist, or athletic trainer. Use a heat pack or a warm soak.

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■ ■ ■ Notify Our Office If

• Symptoms get worse or do not improve in 6 weeks despite treatment

• New, unexplained symptoms develop (drugs used in treatment may produce side effects)