Tarsal Tunnel Syndrome (TTS)

Overview:

Tarsal Tunnel Syndrome (TTS) occurs when the posterior tibial nerve becomes compressed as it passes through the tarsal tunnel, a narrow space on the inside of the ankle. The tarsal tunnel is formed by bones and ligaments and is covered by the flexor retinaculum, a thick ligament that protects crucial structures like arteries, veins, tendons, and nerves. Compression of the tibial nerve leads to TTS, which can cause pain, burning, tingling, or numbness in the foot and toes.

Much like carpal tunnel syndrome, which affects the wrist, Tarsal Tunnel Syndrome results from nerve compression in a confined space. Individuals who overuse their feet and ankles, particularly during strenuous exercise, or those with flat feet are at a higher risk of developing TTS.

Causes

What Causes Tarsal Tunnel Syndrome?

Tarsal Tunnel Syndrome (TTS) occurs when the tibial nerve, which runs through the tarsal tunnel in the ankle, becomes compressed or damaged. This compression can result from various conditions or injuries that place pressure on the nerve.

Common Causes of TTS:

• Flat Feet: Severely flat feet can stretch the tibial nerve, increasing the risk of compression.
• High Arches: Unusually high arches may also contribute to nerve damage.
• Injuries: Ankle sprains, fractures, or other trauma can lead to inflammation and swelling, which can compress the tibial nerve.
• Growths: Benign growths such as ganglion cysts, bone spurs, or varicose veins in the tarsal tunnel can cause nerve compression.
• Masses: Tumors, lipomas, or other abnormal growths near the tibial nerve can also put pressure on the nerve.
• Systemic Conditions: Diabetes, arthritis, and hypothyroidism can make the tibial nerve more vulnerable to compression.

More than 40% of people with TTS have a history of ankle injuries, such as sprains, that contribute to nerve damage. Managing underlying conditions and addressing foot and ankle issues early can help prevent the development of TTS.

Symptoms of Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome (TTS) is characterized by nerve pain that affects the inside of the ankle and the bottom of the foot. The symptoms can range from mild discomfort to severe pain, depending on the extent of tibial nerve compression.

Common Symptoms of TTS:

• Pain: Sharp, shooting pain along the tibial nerve, often felt on the inside of the ankle or the sole of the foot. In severe cases, the pain may extend to the toes, arch, heel, or even the calf.
• Burning Sensations: A feeling of intense heat or burning in the affected area.
• Tingling or “Pins and Needles”: Sensations similar to an electric shock, often triggered by physical activity.
• Numbness: A loss of sensation, particularly in the foot.
• Weakness: Some people may experience muscle weakness in their foot.

Symptom Patterns:

• Aggravated by Activity: Symptoms typically worsen with prolonged standing, walking, or after strenuous physical activity. They may also be triggered by starting a new exercise routine.
• Progression Over Time: For some, symptoms can develop gradually, while for others, they may appear suddenly. If left untreated, TTS can lead to permanent nerve damage, with symptoms persisting even during rest or at night.

Early diagnosis and treatment are crucial for preventing the condition from worsening. Proper evaluation is essential to differentiate TTS from other conditions with similar symptoms and to implement effective treatment.

Other Conditions with Similar Symptoms to Tarsal Tunnel Syndrome

Several foot conditions share symptoms similar to those of Tarsal Tunnel Syndrome (TTS), making accurate diagnosis crucial. These conditions include:

• Bursitis: Inflammation of the fluid-filled sacs (bursae) that cushion bones and tendons.
• Compartment Syndrome: Increased pressure within a muscle compartment, which can affect blood flow and nerve function.
• Plantar Fasciitis: Inflammation of the tissue along the bottom of the foot, often causing heel pain.
• Tendinitis: Inflammation of tendons, leading to pain and swelling around the affected area.

Consulting a healthcare provider is essential for proper diagnosis and treatment.

Treatment of Tarsal Tunnel Syndrome:

The treatment of Tarsal Tunnel Syndrome typically involves a multifaceted approach, with physiotherapy and osteopathy playing vital roles:

Physiotherapy:

• Strengthening Exercises: Physical therapists design customized exercise programs to strengthen foot and ankle muscles, alleviating pressure on the tibial nerve.
• Stretching Routines: Targeted stretches improve flexibility and reduce compression within the tarsal tunnel.
• Gait Analysis: Physiotherapists may conduct gait analyses to identify walking irregularities contributing to Tarsal Tunnel Syndrome and recommend corrective techniques.
• Modalities like Ultrasound: Therapists may use ultrasound and electrical stimulation to reduce inflammation and promote healing in the affected area.

Osteopathy:

• • Manual Manipulation: Osteopathic practitioners employ manual techniques to manipulate bones, muscles, and tissues around the tarsal tunnel, alleviating nerve compression and improving blood circulation.
  • Holistic Approach: Osteopathy considers the interconnectedness of the body’s systems, aiming to restore overall balance and function, which can aid in the overall healing process.

Additional Treatment Options:

In addition to physiotherapy and osteopathy, treatment for Tarsal Tunnel Syndrome may include:

• Rest and Elevation: Resting the affected foot and elevating it can reduce swelling and alleviate symptoms.
• Orthotic Devices: Custom or over-the-counter shoe inserts support the foot’s arch and reduce pressure on the tibial nerve.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to manage pain and inflammation.
• Corticosteroid Injections: In severe cases, healthcare professionals may recommend corticosteroid injections to reduce inflammation around the tarsal tunnel.

Conclusion

Tarsal Tunnel Syndrome can be a debilitating condition, but with proper care, including physiotherapy and osteopathy, individuals can achieve relief and restore mobility. At York Rehab Clinic, we specialize in treating conditions like Tarsal Tunnel Syndrome, offering personalized treatment plans to help you regain function and manage pain effectively. If you suspect you may have Tarsal Tunnel Syndrome, visit York Rehab Clinic for an accurate diagnosis and expert care tailored to your needs.