Tarsal tunnel syndrome is a type of impingement at the inner ankle that produces numbness, pain, tingling, or burning sensations throughout the foot.
You have a nerve called the posterior tibial nerve that runs down the inside of your leg and crosses the inside of your ankle, where it branches off to innervate (give feeling to) different areas of your foot. As it crosses the inside of the ankle, it passes through a naturally-occurring space or ‘tunnel’ between the bones called the tarsal tunnel.
When the space inside the tarsal tunnel is reduced, which can be the result of various injuries, diseases or biomechanical factors related to the structure and function of your foot or ankle, the nerve can become compressed or pinched. It is this compression that produces symptoms that can affect the entire foot and even the lower leg, though they tend to be more prominent on the bottom of the foot and the inside of the ankle.
The symptoms of tarsal tunnel syndrome are classed as ‘neural’, and typically include burning, numbness tingling at the foot and ankle which may be accompanied by shooting pain (which some people describe as electric shocks) or discomfort. Some people may notice their symptoms start very suddenly, while others notice a gradual progression, which is likely associated with the cause of your tarsal tunnel syndrome in your unique case.
The compression or pressure on the posterior tibial nerve can be caused by anything that reduces the space available within the tarsal tunnel. This means that the causes can vary greatly, but may include:
Interestingly, research shows that up to 43% of patients with tarsal tunnel syndrome have a history of trauma including events such as ankle sprains. Abnormal foot biomechanics also contributes to disease progression, as does having hypothyroidism, gout, hyperlipidemia, certain metabolic diseases, and diabetes.
As the key to treating tarsal tunnel syndrome is identifying and managing the cause, having an appointment with your podiatrist for a biomechanical assessment is highly recommended and should be completed as early as possible.
To help reduce your inner ankle pain until you are able get in to see your podiatrist, you can try:
Here at Matt Raden Podiatry, our trusted and experienced podiatrists listen to the concerns, goals and needs of our patients with foot and ankle pain, and utilise a range of evidence-based treatment methods to help you get the best outcome.
Every appointment starts with a comprehensive assessment to understand the biomechanics of your ankles, feet and legs, and all of the factors that are playing a role in compressing the posterior tibial nerve within your tarsal tunnel, or narrowing the space available within the tunnel. As each case can greatly vary, it’s a good idea to take notes of exactly which movements and positions produce or exacerbate your symptoms, as this will give valuable information to your podiatrist to use in their assessment.
We’ll then create a tailored treatment plan based on your results that focuses on helping open up the joint space and treat any issues that are causing swelling within or near the tarsal tunnel. To achieve this, we may use:
If your unique circumstances mean that we are not seeing the typical results we’d expect with treatment, we may refer you for additional care such as cortisone injections to help you manage your symptoms, or for medical imaging to assess for the presence of a cyst in or near the tarsal tunnel. Based on the results, a referral to a specialist like an orthopaedic surgeon may be warranted.
If you’re experiencing inner ankle pain, even if you’re unsure whether it’s tarsal tunnel syndrome or something else, our team is here to help - and to ensure you have the best experience doing so. We’re proud to go above and beyond for our patients, focusing not only on managing your pain and symptoms, but helping you get the best long-term outcomes.