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Tarsal Tunnel Syndrome

The tarsal tunnel is on the inner side of the ankle behind the medial malleolus (the small bump on the inside of your ankle. Tarsal tunnel syndrome is when the tibial nerve is compressed as it passes through the tarsal tunnel, beneath the flexor muscles near the ankle. It is also known as ‘posterior tibial neuralgia’ and can sometimes accompany, or be confused with other conditions including plantar fasciitis or heel spurs (bony lumps that form on the heel bone).

What causes tarsal tunnel syndrome?

Causes include:

  • Ankle sprain or other injuries that cause swelling near the tarsal tunnel and press on the nerve
  • Having flat feet, causing the heel to tilt to the outside and stretch the nerve on the inside of the ankle
  • A ganglion or other swelling that presses on the nerve
  • Diabetes or other disease such as hindfoot or midfoot arthritis that can cause swelling near the tunnel

What are the signs of tarsal tunnel syndrome?

Signs include tingling or numbness that may come and go at first, but gradually become worse. You may also have pain in the arch of your foot.

How is tarsal tunnel syndrome diagnosed?

During your first appointment, you’ll have an opportunity to discuss your symptoms with Mr Heidari, who will be able to advise you on the best course of treatment. He may also arrange X-rays to check for problems such as arthritis or bone spurs, as well as an MRI scan to check for swelling in the tendon.

What does treatment involve?

Not everyone who has tarsal tunnel syndrome needs to have surgery. Using specially designed shoes or insoles can help to relieve pressure on the posterior tibial nerve. You may also be advised to take anti-inflammatory painkillers and, if necessary, have steroid injections to reduce inflammation in the tendon.

In some cases, Mr Heidari may suggest that you follow a tailored programme of exercises, working with a member of the physiotherapy team. If non-operative treatments don’t relieve your pain, you may be offered surgery to remove tissue that is causing the nerve compression.

This information is written as a guide to your treatment but it is not intended to replace the advice of your doctor. Please contact us for advice if you are worried about any aspect of your health or recovery.