Tarsal Tunnel Syndrome is the excessive nerve compression that runs inside the ankle down to the foot. TTS may result from an injury such as an ankle sprain or medical conditions like diabetes or arthritis and is characterized by severe pain, numbness, and a tingling sensation in and around the problem area. The pain associated with this condition can be felt from your ankle, and it spreads to the heel.

Forgoing a doctor’s visit when you experience the symptoms of this condition may result in irreversible nerve damage and affect your mobility. There is a wide variety of treatment options for this condition, depending on your doctor’s diagnosis. One of the highly recommended treatments for TTS is physical therapy. This type of treatment helps revive your foot and restore normal function.

At Suarez physical therapy, we provide specialized physical therapy and rehabilitation to all our clients in Las Vegas, NV, to ensure you properly recover from the condition.

Overview of Tarsal Tunnel Syndrome (TTS)

TTS is a medical condition that describes compression of your tibial nerve through the tarsal tunnel. A tarsal tunnel is a passageway running along the inner side of your ankle, and it can contain one of the two major nerves. Your Tibial nerve controls the muscles between the foot bones. TTS is related to a similar condition that affects the wrists, and the condition is characterized by symptoms such as severe pain when you move your foot, tingling, and numbness of the area.

Causes of TTS

TTS occurs when pressure is applied to the Tibial nerve. Some of the common causes of the condition include:

  • Flat feet. A person is considered to have flat feet when there is no visible arch when they stand. All babies are born without the arch on their foot, and it grows as they get older. If you fail to develop an arch or your collapses later in life, you may experience pain and affect your ability to move your feet.
  • Injuries. Trauma is another significant cause of TTS. Vigorous exercises, a fracture, or a sprain on the ankle could cause pressure to the tarsal nerve and result in this condition.
  • Presence of masses such as lipoma. A lipoma is an overgrowth of fatty tissues under the skin, causing a lump. While most lipomas are not painful and do not need treatment, a mass that develops under the skin near the tarsal could cause a strain and nerve compression resulting in TTS. Therefore, if a lipoma develops around this area, it may need to be removed as soon as possible.
  • Diabetes. For individuals with type 2 diabetes mellitus, the likelihood of TTS is higher because this disease could place their tibial nerve at a higher risk of compression.

While most people can suffer from TTS resulting from the above causes, the following disease conditions will increase your susceptibility to this condition.

  • Gout
  • Hypothyroidism
  • Diabetes
  • Arthritis
  • Varicose veins
  • Nerve disease
  • Hyperlipidemia

Symptoms of Tarsal Tunnel Syndrome

A person with TTS may experience the following symptoms which result from irritation of the Tibial nerve:

  1. Weakness of the lower foot and leg muscles
  2. Foot swelling
  3. Symptoms that worsen with prolonged walking or standing
  4. Increase in ankle or foot temperature
  5. Sharp pain that disrupts sleep
  6. Weakness in the big toe
  7. Burning sensation on the ankle
  8. Numbness and a tingling sensation on the affected foot

Most of these symptoms are felt inside your ankle or the bottom-most part of your foot. Sometimes, one of the symptoms may be more prevalent and occur at one spot of the affected foot. In other cases, the pain, numbness, and tingling sensations spread throughout the toe, arch, and calf.

Some people do not experience these symptoms until the condition has progressed. Aggravated overuse of your foot in activities such as exercising, walking, or prolonged standing could prompt a sudden appearance of the symptoms. If you experience the above symptoms, it is essential to seek immediate medical attention. Failure to treat these symptoms can increase the severity of the condition. Additionally, these symptoms could be mistaken for other conditions. Therefore, seeking medical care ensures that you receive the correct diagnosis and treatment.

Diagnosis and Treatment of Tarsal Tunnel Syndrome

When you visit your doctor with symptoms of TTS, they will ask you various questions regarding the nature of these symptoms. Some of the common symptoms they may be interested in are the foot’s weakness and the inability to twist your ankle or twirl your toes. After assessing your symptoms, the healthcare professional could carry out the following tests before concluding that you have TTS:

  • Tinsel test. The tinsel test is done by tapping the skin above the affected area. When your doctor does this, they will ask you about any signs of shock, pain, or a tingling sensation moving to the bottom of your foot.
  • Nerve biopsy. A nerve biopsy is a test that involves the removal of a small piece of the nerve for examination. The doctor will numb the area during the procedure, create an incision, and remove a part of the nerve. The doctor will then send the sample to the laboratory for testing. Some of the risks associated with this procedure include infection and discomfort in the incision area.
  • Electromyogram test. This is the test used to record the electrical activity of your nerves. The health care professional will insert a needle into the tarsal, and when the muscles move, the ear activity is measured. This test will help determine whether there is a nerve disorder that causes it to move abnormally.
  • Magnetic Resonance Imaging. An MRI is a painless test that produces clear images of the part where it is applied. This procedure uses radio waves and large magnets to produce the images. MRIs are used to determine the level of damage to the nerve. This will also help determine the severity of the condition.

When your condition is not severe, you can manage the symptoms through the following over the counter and home remedies:

  • Rest. You can relieve the pain and numbness around the tarsal by putting less pressure on the problem area as much as possible. This means that you need to take breaks from walking and prolonged standing.
  • Ice. You can place ice packs wrapped with a cloth on the inflamed part. Leaving the ice on foot for at least 20 minutes will help relieve the pain.
  • Anti-inflammatory and pain medications. Taking over-the-counter medications could help relieve inflammation and pain associated with the condition.

In moderate cases of tarsal tunnel syndrome, your healthcare provider could recommend the following non-surgical treatments:

  1. Casts, braces, and splints. The casts or splints help keep your foot in the correct position. This will help avoid straining the foot and promote healing.
  2. Orthotics. Using custom-made inserts in your shoes helps maintain the foot at the right arch and reduces motion of the compressed nerve. Stability in the motion prevents the foot from rolling inwards and reduces the tension on the nerve.
  3. Steroids injections. When the inflammation at the ankle is severe, over-the-counter anti-inflammatory injections may not be effective. The doctor may prescribe steroid injections to help reduce the inflammation in this case.

Surgery for TTS

When other treatments of TTS are not effective or when the condition is severe, your doctor could recommend surgery. The ankle and foot surgeon determines the type of surgery best suits your specific condition. One of the most common surgical procedures for the condition is nerve release.

While performing this procedure, the surgeon makes an opening through the backside to access the problem area. The doctor will then cut through the ligament to stop the Tibial nerve compression. According to a study done in 2021, the success rate for this procedure is 44-96%. You are at a better chance of recovery if you are young, do not have underlying nerve conditions, or receive an early diagnosis.

Another common surgery used to treat TTS is endoscopic surgery. One of the reasons surgeons recommend this procedure is that it is less invasive. Endoscopic surgery for TTS involves making an incision in the inner side of your ankle and pushing in the surgical knife to release the foot’s tissues.

Due to the delicate anatomy of the affected region, tarsal tunnel syndrome surgery may have several complications. One of these complications includes laceration of the posterior artery or nerve. However, this complication may be minimized with careful dissecting and proper identification of the local anatomy. Sometimes, the surgery may fail to release the nerve, causing recurrent symptoms. If you experience the symptoms of TTS, you must seek treatment from an experienced surgeon.

Physical Therapy for Tarsal Tunnel Syndrome

Different levels of TTS are treated with different treatment approaches. However, a physical therapist plays a significant role in helping people recover from this condition. A physical therapist can help you through all the stages of healing, from the diagnosis to recovery and preventing the recurrence of the condition. You can either opt for physical therapy as a standalone treatment or in combination with other treatment options. Your doctor can refer you to a physical therapist, or you can consult the therapist on your own.

A physical therapist is trained to:

  • Give a diagnosis and make a care plan with short and long term goals
  • Conduct a physical exam, review your medical history and evaluate your condition
  • Perform physical treatment interventions
  • Give self-management recommendations and guide you through exercises

Because the symptoms of TTs vary from one person to another, different physical therapy approaches can be used for this condition. Some of the most common recommendations that your therapist could give include:

  • Coordination and balance activities. This type of approach works to improve your balance, which is affected significantly by tarsal tunnel syndrome.
  • Muscle-strengthening exercises. Your therapist could take you through some activities to strengthen the muscles affected by TTS.
  • Nerve gliding activities. Engaging in gentle exercises which involve moving and gliding the nerves.
  • Taping or bracing. This involves ankle taping or foot bracing to help position your foot correctly to reduce the chances of a strain.

In addition to physical manipulation, the physical therapy for TTS involves:

  • Electric stimulation. A physical therapist can use two main types of electric stimulation to treat TTS. Transcutaneous nerve stimulation helps reduce pain, while neuromuscular stimulation helps engage your muscles.
  • Iontophoresis. This is a type of therapy where electric current is used to deliver medications to the affected part of the nerve without the need to make incisions on the skin.
  • Heat and cold therapy are effective for tarsal tunnel syndrome. Cold and heat therapy helps reduce pain and inflammation in the area around the strained nerve.
  • Light therapy. Light therapy involves using lasers and other unique lights to treat the condition.

Depending on the severity of your condition, physical therapy may provide a variety of benefits for individuals battling Tarsal tunnel syndrome, including:

  • Ensures improved balance
  • Minimizes pain and reduces the need for steroids and other pain medications
  • Improves mobility
  • Speeds up recovery from the trauma
  • It helps you avoid surgery

After taking you through the exercises, the physical therapist will educate you on recognizing common symptoms of your condition so you can prevent a recurrence. Managing TTS is easier when you have extensive knowledge about the condition. When you continue physical therapy for up to four weeks, you can notice a significant improvement in your symptoms.

Complications Associated with Tarsal Tunnel Syndrome

Seeking treatment as soon as you experience the symptoms of this nerve condition is vital. If TTS is left untreated, the condition can cause the following complications:

  • Loss of movement of the toes
  • Deformity of the foot
  • Loss of sensation on the foot and toes
  • Repeated and unnoticed foot injuries

While preventing tarsal tunnel syndrome is not guaranteed, you can reduce the risk of developing the condition by:

  • Taking frequent breaks over prolonged periods of standing, walking, or exercise. This could help reduce the stress applied to the tarsal tunnel. Additionally, you can avoid engaging in vigorous exercises.
  • If you have an underlying foot condition, such as a high arch, you need to ensure adequate support for the feet. This can be accomplished using custom orthotics.
  • Frequent exercising aims to improve the strength and flexibility of the leg muscles. Additionally, the exercises can strengthen your muscles and reduce the likelihood of damage.
  • Bracing or using wraps during athletics can reduce the chances of injury.
  • Doing proper warm-up before a vigorous exercise can help protect foot structures from injury.

What Conditions are related to Tarsal Tunnel Syndrome?

Some foot conditions are similar to tarsal tunnel syndrome because they share some symptoms. Therefore, you will need an experienced healthcare provider to help diagnose the specific problem and treat it. Some of these conditions include:


Bursitis is a painful swelling that occurs in the joints. This condition is characterized by swelling of the fluid-filled sacs around the joints. The sacs work to cushion the bone from rubbing off the skin and decrease friction. Then these sacs are irritated, and the area could be inflamed and painful. Some of the most common symptoms of bursitis that may also be present in TTS include:

  • Limited range of motion.
  • Redness around the area
  • Fever and chills
  • Pain when you move

If you experience the above symptoms, you may not be sure of the condition you are suffering from until a doctor examines you. Like with Tarsal Tunnel Syndrome, occupational therapy may help treat bursitis.

Plantar Fasciitis

Plantar fasciitis is a condition that involves inflammation of the thick band of tissue running across the bottom of the foot. The condition is one of the most common causes of heel pain and is characterized by sharp pain when you move. Plantar fasciitis is caused by stress and tension, which cause a tear. Repeated stretching of the area causes irritation and inflammation.


Tendinitis is the irritation and inflammation of the thick fibrous cords attached to the muscles and the bones. Like Tarsal Tunnel Syndrome, tendinitis can affect your heels. The signs and symptoms of tendonitis can occur at the point where the tendon attaches to the bone, and they include:

  • Mild swelling of the joint
  • Tenderness
  • Dull pain when moving the affected heel

Find an Experienced Physical Therapist Near Me

Tarsal Tunnel Syndrome is a rare condition that occurs when the posterior tibial nerve of the foot is compressed. The condition may result from flat feet, an injury, or other health conditions like diabetes. Suffering from TTS can cause severe pain and discomfort when you move your foot. TTS may cause severe complications like nerve damage, motor weakness, and atrophy when left untreated. While applying ice, rest and surgery may help reduce the symptoms, you may need physical therapy when the condition has progressed.

Physical therapy could be very beneficial when dealing with disabilities associated with a condition such as TTS. Seeking treatment from a skilled therapist will help deal with the symptoms and prevent worsening conditions. At Suarez Physical Therapy, we provide top-notch and personalized to all our clients battling tarsal tunnel syndrome in Las Vegas, NV. Call us today at 702-368-6778.