The tarsal tunnel refers to the canal formed between the medial malleolus (part of the ankle bone, this is the bump on the inside of the ankle) and the flexor retinaculum (a band of ligaments that stretches across the foot). Inside the tarsal tunnel are the nerves, arteries, and tendons that provide movement and flexibility to the foot.
One of the nerves in the tarsal tunnel is the tibial nerve, which provides sensation to the bottom of the foot. When this nerve is compressed, the resulting condition is called tarsal tunnel syndrome (TTS). Tarsal tunnel syndrome has also been called posterior tibial neuralgia.
Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as:
Symptoms are typically felt on the inside of the ankle and/or on the bottom of the foot. In some people, a symptom may be isolated and occur in just one spot. In others, it may extend to the heel, arch, toes, and even the calf.
Sometimes, the symptoms of the syndrome appear suddenly. Often, they are brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising, or beginning a new exercise program.
Possible treatment options may include anti-inflammatory medications or steroid injections into the nerves in the tarsal tunnel to relieve pressure and swelling. Orthosis (e.g., braces, splints, orthotic devices) may be recommended to reduce pressure on the foot and limit movement that could cause compression on the nerve.
Depending on the severity of the condition, one of several surgical options may be recommended, including tarsal tunnel release.
In some cases, your doctor may recommend a surgery called the tarsal tunnel release. During this procedure, your surgeon will make an incision from behind your ankle down to the arch of your foot. They will release the ligament, relieving the nerve.
A minimally invasive surgery is also used when possible, in which much smaller incisions are made inside your ankle. The surgeon uses tiny instruments to stretch out the ligament. Because there’s less trauma sustained by the tissues, the risk of complications and recovery time are both reduced.
Recovery after Tarsal Tunnel Surgery is unique to each patient but generally, you will be advised to keep the dressing on your foot until you return to your doctor for follow up, and to avoid getting the stitches wet. Most patients are given a boot to wear to protect their incision. Your stitches will usually be removed 10 days after surgery, at which time you will switch to a supportive walking boot. Most patients have a very good outcome.
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