Tarsal Tunnel Syndrome

Overview

what it is and why it matters

Labeled diagram of the tarsal tunnel and its contents — **Contents of the tarsal tunnel.** Was a bee (Yang et al.) 2017 CC BY 4.0.

Tarsal tunnel syndrome is compression of the tibial nerve (or one of its branches) as it passes through the tarsal tunnel — a fibro-osseous canal on the medial aspect of the ankle beneath the flexor retinaculum. It is the foot analogue of carpal tunnel syndrome. Causes include a space-occupying lesion (ganglion, lipoma, varicosity), flatfoot deformity, post-traumatic fibrosis, or idiopathic.

Symptoms include burning, tingling, or numbness on the plantar surface of the foot, often worse at night or after prolonged standing.

Diagnosis

exam first, imaging second

Tinel's sign behind the medial malleolus. NCS/EMG localizes the compression and assesses severity. MRI and ultrasound identify space-occupying lesions. Tarsal tunnel syndrome is often over- and under-diagnosed; careful NCS interpretation is essential.

Treatment Path

how care progresses at OSI

Orthotic support

Medial arch support reduces tension on the tibial nerve in flatfoot-related cases.

NSAIDs / neuropathic agents

Gabapentin or amitriptyline for neuropathic pain.

Corticosteroid injection

Ultrasound-guided injection can reduce perineural inflammation.

Surgical Options at OSI

if non-operative care isn't enough

Surgical decompression is indicated for confirmed NCS-positive tarsal tunnel syndrome with a space-occupying lesion, or persistent symptoms after 3+ months of conservative care.