Tarsal Tunnel Syndrome


The tarsals are the long bones of the foot. Just below the bony bit on the inside of the ankle (medial malleolus) is a passage where posterior tibial nerves run. The posterior tibial nerve, a major artery, veins, and tendons travel in a bundle along this pathway, through the Tarsal Tunnel. In the tunnel, the nerve splits into three different paths. One nerve (calcaneal) continues to the heel, the other two (medial and lateral plantar nerves) continue on to the bottom of the foot. The Tarsal Tunnel is made up of bone on the inside and the flexor retinaculum on the outside.If you over pronate (your foot rolls in when you walk or run ) then pressure is put on these nerves which can become inflamed causing tarsal tunnel syndrome.

  • Anything that creates pressure in the Tarsal Tunnel can cause TTS. This would include-
  • Benign tumors or cysts
  • Bone spurs
  • Inflammation of the tendon sheath
  • Nerve ganglions
  • Swelling due to a broken or sprained ankle.
  • Varicose veins (that may or may not be visible) can also cause compression of the nerve.
  • TTS is more common in athletes, active people, or individuals who stand a lot. These people put more stress on the tarsal tunnel area.
  • Flat feet may cause an increase in pressure in the tunnel region and this can cause nerve compression. Those with lower back problems may have symptoms. Back problems with the L4, L5 and S1 regions are suspect and might suggest a “Double Crush” issue. One “crush” (nerve pinch or entrapment) in the lower back and the second in the tunnel area


  • Pain (possibly sharp) radiating into the arch of the foot, heal and sometimes the toes.
  • Inflammation or swelling can occur within this tunnel for a number of reasons.   The flexor retinaculum doesn’t stretch much, so increased pressure will eventually cause compression on the nerve within the tunnel. As pressure increases on the nerves, the blood flow decreases. Nerves respond with altered sensations like tingling and numbness in the sole of the foot.
  • Pain when running.
  • Pain when standing for long periods of time.
  • burning sensation on the bottom of foot and radiating upward
  • Fluid collects in the foot when standing and walking and this makes the condition worse. As small muscles lose their nerve supply they can create a cramping feeling


  • Patients’ report of their pain and a positive Tinel’s sign are the first steps in evaluating the possibility of tarsal tunnel syndrome.
  • An MRI and nerve conduction studies are common. Common causes are neuropathy and space occupying anomalies within the tarsal tunnel. Varicose veins within the tunnel are a common cause.
  • A neurologist usually administers nerve conduction tests. During this test, electrodes are placed at various spots along the nerves in the legs and feet. Both sensory and motor nerves are tested at different locations. Electrical impulses are sent through the nerve and the speed and intensity at which they travel is measured. If there is compression in the tunnel, this can be confirmed and pinpointed with this test. Many doctors do not feel that this test is necessarily a reliable way to rule out TTS. Some research indicates that nerve conduction tests will be normal in at least 50% of the cases. It is possible to have TTS without a positive nerve conduction test.



At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

  • Pain relief with electrotherapy
  • Reduce swelling
  • Strengthening of muscle
  • Flexibility training
  • Regain full range of motion
  • Taping of foot for support
  • Prescription of orthosis

Visit Physioline for further Consultation and treatment