Tarsal Tunnel Syndrome – Causes, Symptoms, Treatment & Physiotherapy Management

Introduction

Do you feel burning pain, tingling, numbness, or electric shock sensations in your foot or ankle? These symptoms may be caused by Tarsal Tunnel Syndrome (TTS) — a painful nerve compression condition affecting the foot and ankle region.

At Physio360, we frequently treat patients suffering from foot pain, ankle pain, nerve compression, walking difficulty, and sports-related lower limb conditions. Early diagnosis and proper physiotherapy treatment can help prevent long-term complications and improve mobility.

What is Tarsal Tunnel Syndrome?

Tarsal Tunnel Syndrome is a condition where the posterior tibial nerve gets compressed or irritated as it passes through the tarsal tunnel, a narrow space located on the inner side of the ankle.

The tarsal tunnel is covered by a thick ligament called the flexor retinaculum. When swelling, inflammation, injury, or biomechanical problems increase pressure inside this tunnel, the nerve becomes compressed, leading to pain and neurological symptoms.

It is similar to carpal tunnel syndrome in the wrist, but it occurs in the ankle and foot.

Anatomy of the Tarsal Tunnel

The tarsal tunnel contains:

✔ Posterior tibial nerve

✔ Tendons of foot muscles

✔ Blood vessels

✔ Flexor retinaculum

Compression of the tibial nerve affects sensation and muscle function in the foot.

Causes of Tarsal Tunnel Syndrome

Several conditions can contribute to nerve compression inside the tarsal tunnel.

Common Causes

1. Flat Feet (Pes Planus)

Collapsed arches increase tension on the tibial nerve.

2. Ankle Injury

Previous ankle sprain, fracture, or trauma may cause swelling and scar tissue formation.

3. Overuse Injuries

Running, prolonged standing, walking, or sports activities may irritate the nerve.

4. Swelling and Inflammation

Conditions causing fluid accumulation can compress the nerve.

5. Varicose Veins or Ganglion Cysts

Space-occupying lesions inside the tunnel may increase pressure.

6. Arthritis

Inflammation in nearby joints can contribute to nerve irritation.

7. Diabetes

Peripheral nerve sensitivity may worsen symptoms.

8. Poor Foot Biomechanics

Abnormal gait patterns and improper footwear may aggravate the condition.

Symptoms of Tarsal Tunnel Syndrome

Symptoms usually develop gradually and may worsen with prolonged activity.

Common Symptoms Include:

✔ Burning sensation in the foot

✔ Tingling or numbness in the sole

✔ Sharp shooting pain in the ankle

✔ Electric shock-like sensations

✔ Pain radiating to toes or calf

✔ Weakness in foot muscles

✔ Increased pain during walking or standing

✔ Night pain or discomfort

✔ Foot fatigue during activities

Some patients describe the feeling as “walking on pins and needles.”

Risk Factors

Certain individuals are more prone to developing Tarsal Tunnel Syndrome.

High-Risk Groups

✔ Athletes and runners

✔ People with flat feet

✔ Workers standing for long hours

✔ Obesity

✔ Diabetic patients

✔ Elderly individuals

✔ People with previous ankle injuries

✔ Individuals wearing improper footwear

Diagnosis of Tarsal Tunnel Syndrome

A detailed clinical assessment is important for accurate diagnosis.

At Physio360, assessment includes:

Subjective Evaluation

✔ Pain history

✔ Aggravating activities

✔ Functional limitations

✔ Walking difficulty

Physical Examination

✔ Tenderness over the tarsal tunnel

✔ Sensory testing

✔ Muscle strength testing

✔ Foot posture assessment

✔ Gait analysis

Special Tests

✔ Tinel’s Sign

✔ Dorsiflexion-Eversion Test

✔ Nerve tension testing

Investigations

Doctors may recommend:

✔ MRI

✔ Ultrasound

✔ Nerve conduction studies

✔ X-ray

Physiotherapy Treatment for Tarsal Tunnel Syndrome

Physiotherapy plays a major role in reducing pain, improving nerve mobility, correcting biomechanics, and restoring function.

At Physio360 Chennai, we focus on non-surgical rehabilitation and long-term recovery.

Goals of Physiotherapy

✔ Reduce pain and inflammation

✔ Relieve nerve compression

✔ Improve ankle mobility

✔ Correct foot mechanics

✔ Improve muscle strength

✔ Restore walking ability

✔ Prevent recurrence

Physiotherapy Management

1. Pain Relief Techniques

Modalities Used

✔ IFT (Interferential Therapy)

✔ TENS

✔ Ultrasound Therapy

✔ Cryotherapy (Ice Therapy)

✔ Laser Therapy

These treatments help reduce inflammation and nerve irritation.

2. Manual Therapy

Manual therapy techniques improve joint and soft tissue mobility.

Techniques Include

✔ Soft tissue release

✔ Myofascial release

✔ Ankle mobilization

✔ Neural mobilization

✔ Trigger point release

3. Nerve Gliding Exercises

Nerve mobilisation exercises help improve nerve movement and reduce compression.

Benefits

✔ Reduces tingling

✔ Improves nerve flexibility

✔ Decreases pain

✔ Enhances circulation

4. Stretching Exercises

Tight muscles can increase pressure around the ankle.

Common Stretches

✔ Calf stretch

✔ Achilles tendon stretch

✔ Plantar fascia stretch

✔ Hamstring stretch

5. Strengthening Exercises

Strengthening improves foot stability and arch support.

Exercises Include

✔ Toe curls

✔ Towel scrunches

✔ Heel raises

✔ Theraband ankle exercises

✔ Intrinsic foot muscle strengthening

6. Balance and Proprioception Training

Balance exercises improve ankle stability and reduce reinjury risk.

Examples

✔ Single-leg standing

✔ Balance board training

✔ Functional gait drills

7. Footwear Advice

Proper footwear significantly helps reduce symptoms.

Recommended Footwear Features

✔ Arch support

✔ Cushioning

✔ Wide toe box

✔ Shock absorption

✔ Proper heel support

Orthotics may also be prescribed when necessary.

Home Care Tips

✔ Avoid prolonged standing

✔ Apply ice for 15–20 minutes

✔ Maintain a healthy body weight

✔ Wear supportive footwear

✔ Avoid excessive running during flare-ups

✔ Perform stretching exercises regularly

When is Surgery Needed?

Surgery may be considered if:

✔ Severe nerve compression exists

✔ Conservative treatment fails

✔ Persistent numbness occurs

✔ Muscle weakness develops

✔ Space-occupying lesions are present

However, many patients improve significantly with physiotherapy management.

Prevention of Tarsal Tunnel Syndrome

Prevention Tips

✔ Warm up before exercise

✔ Maintain ankle flexibility

✔ Use proper footwear

✔ Avoid repetitive ankle strain

✔ Correct flat feet early

✔ Strengthen foot and ankle muscles

REVIEW OF LITERATURE

1. Tarsal Tunnel Syndrome https://www.ncbi.nlm.nih.gov/books/NBK513273/