Tarsal Tunnel Syndrome

Definition

Tarsal Tunnel Syndrome: Foot pain and neuropathy caused by compression of the tibial nerve within the tarsal tunnel.

General Info

Tarsal bones are the short bones located in the midfoot and rearfoot that form a bridge between the ankle and the metatarsal bones. The tarsal tunnel is a space located just below the bony prominence on the inside of the ankle, or medial malleolus, and is made up of bone on the inside and the flexor retinaculum—a band of connective tissue—on the outside. Several important structures pass through the tarsal tunnel, including tendons, blood vessels, and the tibial nerve. Compression of any of these tarsal tunnel structures can cause foot problems.

Tarsal tunnel syndrome, also known as tibial nerve dysfunction or neuralgia, occurs when the tibial nerve—the nerve that supplies movement and sensation to the foot muscles—becomes entrapped or compressed within the tarsal tunnel. The parts of the foot affected by this compression neuropathy depend on the area of entrapment. Increased pressure within the tarsal tunnel causes compression of the tibial nerve and sensations such as numbness, tingling, and cramping. Any problem or condition that causes inflammation and swelling—and thereby pressure—within the tarsal tunnel can cause tarsal tunnel syndrome.

Signs & Symptoms

Some of the most common signs and symptoms associated with tarsal tunnel syndrome include:

• Foot pain
• Foot, ankle, and toe weakness
• Burning, numbness, cramping, or other unusual sensations in the foot

Possible Causes

The underlying cause of tarsal tunnel syndrome is often difficult to determine. But anything that increases pressure in the tarsal tunnel can cause this health problem, including benign tumors or cysts, tendon sheath inflammation, bone spurs, nerve ganglions, and varicose veins. Direct trauma is another possible cause of tarsal tunnel syndrome.

Excessive ankle pronation (the inward rolling of the ankle) may compress the tibial nerve, leading to tarsal tunnel syndrome. Most conventional footwear holds the foot in a position in which excessive pronation is inevitable. Heel elevation, toe spring, and tapering toe boxes—common design elements built into conventional footwear—act together to destabilize the main foot arch and cause overpronation. A person with this foot health problem may experience symptoms on both sides of his or her body if the tarsal tunnel syndrome is caused by inappropriate footwear.

Most conventional footwear holds (and essentially immobilizes) the big toe in a bunion configuration (i.e., big toe extended and pointing toward the second toe). In this configuration, the abductor hallucis muscle pulls on the flexor retinaculum, which in turn clamps down on the structures passing through the tarsal tunnel, including the tibial nerve. Conventional footwear may be one of the most common causes of tarsal tunnel syndrome, though this possibility is rarely discussed in foot care circles.

Helpful Strategies

Swapping conventional footwear for men’s and women’s foot-healthy footwear may be one of the most effective treatment (and prevention) strategies for tarsal tunnel syndrome. Realigning the toes using Correct Toes and anatomically appropriate footwear will help minimize or eliminate excessive foot pronation and reduce the tension of the flexor retinaculum on the tibial nerve and other structures passing through the tarsal tunnel.

Other beneficial conservative treatment strategies may include:

• Rest
• Cold therapy
• Physical therapy
• Natural anti-inflammatory agents

Always consult a physician before beginning any foot health regimen designed to treat tarsal tunnel syndrome.