What to know about Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome occurs when the posterior tibial nerve, which runs along the inside of the ankle and foot, becomes compressed and damaged, causing inflammation.
The condition, also known as TTS, is usually caused by continual overuse of the foot and ankle, such as occurs with strenuous or prolonged walking, running, standing, or exercising.
But TTS can also occur suddenly after traumatic injury, or spontaneously, for no clear reason.
Fast facts on TTS
- TTS is considered a relatively rare condition.
- Severe or untreated cases may cause permanent nerve damage.
- Exercises to stretch the affected tissues should be performed.
What are the treatment options?
A doctor should always assess and treat symptoms of TTS early.
The first line of treatment for TTS is RICE, which stands for rest, ice, compression, and elevation.
Over-the-counter non-steroidal anti-inflammatory medications, or NSAIDs, such as acetaminophen or ibuprofen, can also help make symptoms more manageable.
For more severe or chronic cases, more aggressive treatment options exist, such as corrective devices, therapies, and in some cases, surgery.
Common ways to manage and treat TTS include:
Rest: The easiest and most immediate way to reduce inflammation anywhere in the body is to stop using and putting pressure on the affected area. How long an individual should rest the foot depends mostly on the severity of symptoms. For minor cases, rest may mean replacing running with swimming. For more severe cases, resting the nerve may require completely refraining from exercise and activity.
Ice: An ice pack covered with a cloth or towel can be applied to the inside of the ankle and foot for 20-minute sessions to reduce inflammation. It is best to have the foot elevated during this time. Icing sessions can be repeated several times daily, as long as breaks of at least 40 minutes are taken.
Compression and elevation: Compressing the foot, and keeping it raised above the heart, helps reduce blood flow to the foot, and so reduces inflammation. Try wrapping the foot with an ACE wrap, and resting it on a pillow while sitting and sleeping.
Over-the-counter pain and anti-inflammatory medications: These can include ibuprofen and acetaminophen.
Full immobilization: For severe cases, especially those involving physical damage to the nerve, a cast may be necessary to restrict movement completely, allowing the nerve, joint, and surrounding tissues a chance to heal.
Injection therapy: For very painful or disabling symptoms, anti-inflammatory medication, such as corticosteroids and local anesthetics, may be directly injected into the nerve.
Orthopedic devices and corrective shoes: Podiatrists can make specialized shoes, and inserts that help support the arch and limit motions that can further irritate the inflamed nerve and surrounding tissues. Shoes also exist to help prevent pronation or inward rolling of the foot.
Reducing foot pressure: In some cases, wearing looser or larger fitting footwear and socks may help reduce tightness around the foot.
Physical therapy: Physical therapy exercises can often help reduce symptoms of TTS long-term, by slowing stretching and strengthening the connective tissues, mobilizing the tibial nerve and opening the surrounding joint space to reduce compression.
Other types of physical therapy used for TTS include:
- ultrasound therapy
- manual therapy
- taping or bracing
Ultimately, surgery may be performed for very severe or chronic cases of TTS that do not respond to any other form of medical or physical therapy.
RIVERA FOOT & ANKLE: At Orlando H.Rivera DPM, our priority is to deliver quality care to informed patients in a comfortable and convenient setting. When you have problems with your feet, you need to turn to a podiatrist who listens and responds… an experienced doctor who knows the field and can effectively diagnose and treat your needs… a friendly physician who counsels you on the best ways to maintain and improve your health. Our physician(s) meet all these criteria. Plus, you benefit from a dedicated team of trained professionals who give you the individualized attention you deserve.
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