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Tarsal Tunnel Syndrome

27/09/2019 by Pivotal Motion

Tarsal Tunnel Syndrome or TTS is similar to carpal tunnel syndrome that is seen in the foot.

Tarsal Tunnel Syndrome is a condition that is attributed to unnatural compression of a nerve and can create a neuropathy of the nerve.

The tarsal tunnel is found behind the medial mallelous or the inside of the anklebone. There are a number of structures that pass through the tarsal tunnel. A thick ligament holds all of the structures in place but when there is inflammation or compression of that space it creates pain and dysfunction distal to the tarsal tunnel.

Tarsal tunnel syndrome is a condition that causes painful, burning, or numb sensations throughout the inside aspect and bottom of the foot.

What is the Tarsal Tunnel?

The tarsal tunnel is an area of the foot located just behind the inside (medial) anklebone. It is an area that is particularly important.

There are a number of arteries, veins, tendons, and nerves that run their course through it that are responsible for innervating the bottom of the foot.

One nerve in particular is the posterior tibial nerve.

The posterior tibial nerve runs through the tarsal tunnel and then continues on to the bottom of the foot.  The nerve then splits into branches of nerves that are responsible for providing sensation and movement from the bottom of the foot right up to the toes.


  • Flat foot or over pronation
  • An increase in size of one of the structures that pass through the TS
  • Inflammation in the area of the TS
  • Disease such as osteoarthritis, rheumatoid arthritis, and diabetes can cause swelling in the tunnel

What can aggravate the Tarsal Tunnel Syndrome?

Often the TSS will be exacerbated with increased activity and settled with rest. In some circumstances, TSS may be worse at night, or when the foot is resting.

Because the area of the tarsal tunnel is so busy, there are many structures that can cause impingement of the nerve and can interrupt the proper nerve signal. One common cause is excessive pronation, or feet that have a tendency to roll in.

The alignment of the bones can cause pressure against the nerve, altering the signal. An injury to the area can have a similar effect.

A cystic or tumor growth in the area, varicose veins, muscle and tissue tightness, or inflammation of a tendon in the area can also be the cause.

Treatment of Tarsal Tunnel Syndrome.

  • Following the R.I.C.E principal to settle down the inflammation and let the body recover
  • Anti-inflammatory medication to reduce swelling
  • Immobilization of the area
  • Manual therapy from a physiotherapist
  • Following a structured exercise program from a physiotherapist to improve the range of motion of the joints nearby.
  • Very very rare cases will require surgery to reduce the pressure through the area.


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