Tarsal Tunnel Syndrome: Causes, Diagnosis and Treatment

Tarsal tunnel syndrome is caused by compression of the tibial nerve in the canal formed by the flexor retinaculum and the foot bones. This canal is called tarsal tunnel. See the graphic below.

Before reading on it would be good to first understand the anatomy of the foot (skip this if you already done so).

Causes of compression include

• tenosynovitis (swelling of the synovial membrane lining the tendons)
• tumors such as lipoma, ganglion, xanthoma and neurilemmoma
• rheumatoid arthritis
• osteoarthritis
• fractures of the talus, tibia or calcaneum bones
• fibrosis around the tibial nerve
• pregnancy
• varicose veins
• presence of extra muscle tissue in the tarsal canal

Symptoms include

• abnormal sensation such as tingling and numbness in the sole or toes
• symptoms may vary through out the day or with exercise and rest or with position of the limb
• foot may feel dry in one half or the other
• foot may feel cold in one half or the other

On clinical examination pressure over the nerve may produce abnormal sensations in the foot (Tinel test). Decreased sensation in the foot may be present.

Diagnostic tests include

• electromyography and nerve conduction studies
• x rays of the foot
• CT and MRI scans

All the above mentioned tests may not be required.

Treatment non-operative and operative.

Non-operative treatment includes

• anti-inflammatory medication
• injection of steroid into the tarsal tunnel
• intermittent immobilization of the foot and ankle in a splint

Operative treatment includes surgical release of the flexor retinaculum along with excision of any tumor or other space occupying lesion in the tarsal tunnel.

Anterior Tarsal Tunnel Syndrome

It is a condition in which the deep peroneal nerve is compressed below the inferior extensor retinaculum of the foot.

Symptoms include

• abnormal sensations in the toes and web spaces
• symptoms increase with walking and running
• sensations are reduced in the foot

It is more common in runners and athletes.

It is caused by the formation of a osteophyte (bone spur) in the joints of the foot.

Diagnosis is by nerve conduction studies.

Treatment includes

• anti-inflammatory medication
• injection of steroid
• excision of the bone spurs is done if there is no response to the above treatments

Frequently Asked Questions

About 3 out of every 4 patients who undergo surgery for this condition report satisfactory improvement. Chances of recovery are better if a tumor or other compressive lesion is the cause of symptoms.

How long does it take for completely recovery after surgery?

Complete recovery usually takes 3 to 4 weeks. The anterior syndrome can take 4 to 6 weeks.

What can be the cause of persistent symptoms after surgery?

Persistent symptoms after surgery can be due to

• wrong diagnosis
• inadequate release of the compression
• injury to the nerve during surgery

I hope the information provided was helpful. If you have any query you can ask me at the contact me page.

This page was last updated on 23th June 2009.