Tarsal Tunnel Syndrome (TTS)

This blog discusses a relatively common foot condition that can be painful and restricts ease of movement. Here at The Footcare Centre we can offer a variety of services that may be of benefit which are discussed below.

What is the tarsal tunnel?

Tarsal tunnel is a narrow space located next to the ankle bone and is served by arteries, veins, tendons and nerves.  Overlying the tarsal tunnel is the flexor retinaculum, which is responsible for protecting and maintaining the structures located in the tunnel.

What is Tarsal Tunnel Syndrome (TTS)?

TTS also known as posterior tibial neuralgia occurs when there is either compression or squeezing on the posterior tibial nerve. The condition can arise as there is very little give within the tunnel, hence when this space inside the tunnel becomes tight the tibial nerve will become either compressed or impinged.

What are the causes of TTS?

The condition can be caused by an array of factors, which can compress the tibial nerve, however it is difficult to determine the exact cause of the condition:

  • Patients who suffer with flat feet are at higher risk for developing tarsal tunnel syndrome because the outward tilting of the heel that occurs with collapsed arches can produce strain and compression on the nerve.
  • An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon, and arthritic bone spur.
  • An injury, such as an ankle sprain, can cause inflammation and swelling in or around the tunnel, resulting in compression of the nerve.
  • Systemic diseases such as diabetes or arthritis can cause swelling, hence compressing the nerve.

Symptoms of TTS

Patients suffering from TTS can experience one or more of the following symptoms:

  • Pain and tingling in and around the ankle and sometimes in the 1st 2nd and 3rd
  • Swelling in the feet
  • Patients can suffer from painful burning, tingling or numbness in the lower limbs. Pain worsens and spreads after standing for long periods of time or prolonged activities.
  • Electric shock sensations
  • Pain can radiate up into the leg and down into the arches heels and toes.
  • Hot and cold sensations within the feet.
  • Positive Tinel’s test. Tinel’s test is a tingling electric shock sensation that occurs when the practitioner taps over the affective nerve. The sensations usually travels into the foot, however it can also travel up the leg.
  • Patients will suffer from ‘Pins and needles’ sensation across the foot.
  • Pain will be more pronounced while driving.


Diagnosis for TTS is dependent upon the practitioner’s examination findings. Obtaining an accurate pain history and identifying a positive Tinel’s test are the initial steps in diagnosing the condition. Imaging can be used to rule out differential diagnosis and also to identify the cause of the condition.

Treatment for TTS

There are numerous treatment and advice plans that The Footcare Centre can offer for patients suffering from TTS:

  • Staying off the foot prevents further injury and encourages healing.
  • Apply an ice pack to the affected area, apply ice pack for 20 minutes and then wait at least 40 minutes before icing again.
  • Patients can be advised to takenonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.
  • Immobilization,restricting movement of the foot by wearing a cast is sometimes necessary to enable the nerve and surrounding tissue to heal.
  • Physical therapy such as low level laser therapy and exercises,
  • Injection therapy,use of a local anaesthetic can provide pain relief, and an injected corticosteroid may be useful in treating the inflammation.
  • Orthotic devices,custom made orthotics can be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve.
  • Footwear, supportive shoes may be recommended to help stabilise the foot as the patient walks.
  • Bracing,patients with flatfoot or those with severe symptoms and nerve damage may be fitted with a brace to reduce the amount of pressure on the foot.

Please do not hesitate to contact The Footcare Centre to book a consultation with one of the podiatrists if you think you are suffering with this. To make an appointment either book online or call 01932 849373.

This has been written by Anuj Soni and is the opinion of the blogger and not necessarily that of The Footcare Centre LTD

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