Merck Manual

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Tarsal Tunnel Syndrome

(Posterior Tibial Nerve Neuralgia)

By

James C. Connors

, DPM, Kent State University College of Podiatric Medicine

Reviewed/Revised Dec 2023
VIEW PROFESSIONAL VERSION

Tarsal tunnel syndrome is pain in the ankle, foot, and sometimes toes caused by compression of or damage to the nerve supplying the heel and sole (posterior tibial nerve).

  • Symptoms include burning or tingling pain that occurs when people walk or wear certain shoes.

  • The diagnosis is based on an examination of the foot and nerve conduction studies.

  • Corticosteroid injections, orthoses, and sometimes surgery are needed to relieve the pain.

The posterior tibial nerve runs down the back of the calf, through a fibrous canal (tarsal tunnel) near the heel, and into the sole of the foot. When tissues around the tarsal tunnel become inflamed, they can swell and press on the nerve (nerve compression), causing pain.

Disorders that can cause or contribute to tarsal tunnel syndrome include fracture, ankle swelling caused by heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more Heart Failure (HF) or kidney failure Overview of Kidney Failure Kidney failure is the inability of the kidneys to adequately filter metabolic waste products from the blood. Kidney failure has many possible causes. Some lead to a rapid decline in kidney function... read more , and an underactive thyroid gland (hypothyroidism Hypothyroidism Hypothyroidism is underactivity of the thyroid gland that leads to inadequate production of thyroid hormones and a slowing of vital body functions. Facial expressions become dull, the voice... read more Hypothyroidism ). Also, disorders such as gout Gout Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid (hyperuricemia). The accumulations of crystals cause flares (attacks)... read more Gout or rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more Rheumatoid Arthritis (RA) cause inflammation in the joints. Poor foot posture may also contribute if the ankle rolls too far inward and stresses the nerve within the tarsal tunnel.

Symptoms of Tarsal Tunnel Syndrome

Pain, the most common symptom of tarsal tunnel syndrome, usually has a burning or tingling quality that may occur when a person stands, walks, or wears a particular type of shoe. Pain located around the ankle (usually on the inner side) and extending to the toes usually worsens during walking and is relieved by rest. As the disorder progresses, pain also may occur during rest.

Diagnosis of Tarsal Tunnel Syndrome

  • A doctor's examination of the foot

  • Sometimes nerve conduction studies

  • Sometimes MRI (magnetic resonance imaging)

To diagnose tarsal tunnel syndrome, a doctor manipulates the affected foot during a physical examination. For example, tapping the injured or compressed area just below the ankle bone often causes tingling (referred to as the Tinel sign), which may extend to the heel, arch, or toes.

Nerve conduction studies Nerve conduction studies Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Imaging tests commonly used to diagnose nervous system (neurologic) disorders... read more Nerve conduction studies may be useful to determine the cause or extent of the injury, especially if foot surgery is being considered. Sometimes an MRI is helpful to evaluate the surrounding structures that might be contributing to nerve compression.

Treatment of Tarsal Tunnel Syndrome

  • Corticosteroid injections

  • Orthoses

  • Sometimes surgery

Other treatments include wrapping the foot and placing specially constructed devices in the shoe (orthoses).

When other treatments do not relieve the pain, surgery to relieve pressure on the nerve may be necessary.

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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