Tarsal tunnel syndrome (TTS) sounds familiar, doesn’t it? That is because treating carpal tunnel syndrome is similar to tarsal tunnel syndrome. Both disorders relate to the compression of a nerve in a confined area.
The carpal tunnel is the very small opening below the wrist, and between the arm and hand, whereas tarsal tunnel syndrome affects the nerves inside the ankle.
Tarsal tunnel syndrome is also called posterior tibial nerve neuralgia. The condition causes a squeezing, or compression, on the posterior tibial nerve that leads to pain and other symptoms along the nerve path to the inside of the ankle and into the foot.
What Causes Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome is caused by any condition that puts compression on the posterior tibial nerve, including:
- Flat feet or fallen arches;
- An enlarged or abnormal structure, including a swollen tendon, arthritic bone spur, ganglion cyst, or varicose vein;
- Swelling and inflammation from an injury such as an ankle sprain or fracture; and
- Systemic diseases such as rheumatoid arthritis and diabetes.
Other possible causes include ankle venous stasis edema, fibrosis, or abnormal foot function.
Who Is Affected by Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome is rare, so rare in fact that there aren’t any recorded statistics on its prevalence. On the other hand, carpal tunnel syndrome affects at least 10% of those who work at a computer on a regular basis.
Tarsal tunnel syndrome is thought to affect both women and men equally. Hypothyroidism sufferers may also develop symptoms similar to tarsal tunnel syndrome due to perineural mucin deposition, which involves the skin producing abnormal amounts of mucin (a component of mucus).
Recognizing the Symptoms of Tarsal Tunnel Syndrome
There are certain tarsal tunnel syndrome symptoms related with the condition. These symptoms are typically experienced on the inside of the ankle or the bottom of the foot, but they may also extend to the toes, the arch of the foot, the heel, and the calf. Tarsal tunnel syndrome often appears suddenly, and is brought on from the overuse of the foot, such as prolonged standing, or excessive walking or exercising; beginning a new exercise program can aggravate tarsal tunnel syndrome symptoms.
The following are the main symptoms associated with tarsal tunnel syndrome:
- Pain, especially shooting pain
- Tingling and burning that is sometimes found in the plantar medial heel; the sensation is similar to an electrical shock
Diseases Associated with Tarsal Tunnel Syndrome
Besides carpal tunnel syndrome, tarsal tunnel syndrome symptoms can be similar to other disorders. Tarsal tunnel syndrome and plantar fasciitis are similar foot disorders, though the pain presents itself differently. Plantar fasciitis is commonly described as inflammation of the thick tissue at the bottom of the foot, or plantar fascia, and a sharp pain in the heel is felt; however, it’s not the same pain as the tingling and shooting pain linked with tarsal tunnel syndrome. Plantar fasciitis develops gradually, and the pain is worse in the morning, but it improves with stretching exercises. Other conditions linked with tarsal tunnel syndrome that can cause pain in the ankle or foot include:
- Diabetes, especially diabetic neuropathy;
- Posterior tibial tendinosis;
- Stress fractures;
- Rare disorders, such as reflex sympathetic dystrophy; and
- Disorders that affect the outer nerves of the central nervous system, such as peripheral neuropathy.
How to Diagnose Tarsal Tunnel Syndrome
The diagnosis of the condition is based upon a comprehensive clinical evaluation through identifying various tarsal tunnel syndrome symptoms, taking a detailed history of the patient, and administering a variety of specialized tests. An example of a tarsal tunnel syndrome test is a Tinel’s sign test, which can detect an irritated nerve. In this test, the doctor will apply pressure or tap the tibial nerve, and if the tapping causes a “pins and needles” or tingling sensation in the toes or foot, it’s considered a positive sign of tarsal tunnel syndrome.
Another tarsal tunnel syndrome test may include either electromyography (EMG) or magnetic resonance imaging (MRI). An MRI is used to detect an irritated nerve, and electromyography can help determine nerve dysfunction in relation to tarsal tunnel syndrome. A nerve conduction velocity test may also be given if tarsal tunnel syndrome does not improve with non-surgical treatment.
Natural Treatments for Tarsal Tunnel Syndrome
What is the best tarsal tunnel syndrome treatment? Conventional treatment includes non-steroidal anti-inflammatory drugs (NSAIDs), contrast baths, corticosteroid injections, and non-rigid orthotic devices such as splints and braces that help correct or protect the position of the foot. Sometimes tarsal tunnel syndrome surgery is considered the best option for those who fail to respond to conventional treatment. This is called tarsal tunnel release surgery, which works by decompressing the nerve within the tarsal tunnel.
There are also various natural tarsal tunnel syndrome treatments, such as:
1. Ice Pack
An ice pack to decrease swelling is the first thing your doctor will recommend. Apply an ice pack on the affected area for 20 minutes, and remember to place a thin towel between your skin and the ice. Wait for a minimum of 40 minutes before using the ice pack again.
2. Massage Therapy
There are various ways that bodywork and message therapy can treat tarsal tunnel syndrome. A registered massage therapist can help alleviate muscular agitation in the ankle and foot. They may use trigger point therapy or neuromuscular therapy to eliminate myofascial trigger points and tension of the flexor muscles that connect with the tarsal tunnel. Other techniques used to treat tarsal tunnel syndrome include deep tissue massage techniques, myofascial release techniques, and muscle energy techniques.
In traditional Chinese medicine, chronic tarsal tunnel syndrome is caused by a root qi deficiency of the middle jiao. Electro-acupuncture and regular acupuncture can treat the affected area in tarsal tunnel syndrome. Studies have also found that acupuncture can treat potential causes of tarsal tunnel syndrome, including diabetic neuropathy.
4. Anti-inflammatory Supplements
There are a number of anti-inflammatory supplements that can help alleviate the pain linked with tarsal tunnel syndrome, including white willow, boswellia, and bromelain. Topical oils and creams with arnica and St. John’s wort can also reduce swelling and pain.
5. Other Natural Nutrients and Remedies
Certain studies have found that vitamin B6 can reduce the nerve inflammation linked with tarsal tunnel syndrome. Calcium and magnesium taken together can also decrease nerve irritation and muscle tightness. Other natural pain relievers include DMSO (dimethyl sulfoxide), dandelion leaf, and ginkgo biloba.
6. Homeopathy for Tarsal Tunnel Syndrome
Homeopathy is another natural therapy that is considered very effective in tarsal tunnel syndrome treatment. It’s best to see a trained homeopath for the most effective remedy based on your physical, mental, and emotional symptoms. The following are the most popular homeopathic remedies for tarsal tunnel syndrome:
- Arnica montana: Arnica is the go-to remedy for trauma from bruising and shock, especially from a deep bruising pain after the first couple of days following an injury. The area will also likely feel weak, swollen, and strained due to the stitching pain.
- Rhus toxicodendron: Rhus toxicodendron is great for sprains in general. It’s also helpful when you have a stinging pain in the left heel.
- Ruta graveolens: Ruta is always best when there is damage to the tendons, tendon sheath, ligaments, and the tarsal joint. It’s also excellent for stiff and bruising pain.
- Hypericum: Hypericum is often the remedy of choice when there is an injury to a nerve with shooting pains.
There are also certain homeopathic remedies that can effectively treat causes related to tarsal tunnel syndrome. Hekla lava and calcarea fluorica can specifically treat bone spurs, while ruta is also used for ganglions on flexor tendons.
Exercises for Tarsal Tunnel Syndrome
A proper warm-up before exercising can help prevent injury around the nerve, which also reduces the likelihood of compression. It’s useful to start a strengthening program to help support the muscles of the lower leg, and reduce the chance of potential injuries to the leg or ankle. Flexibility in the lower leg and muscles will also keep the foot and ankle in proper alignment, which reduces the strain on the tendons when resting. When your muscles are flexible, you are less likely to get injured. There are also specific tarsal tunnel syndrome exercises that help treat the condition, including the following:
Ankle rotation: Like the rest of your body, it’s best to exercise your ankles to help keep them strong. First, sit in a chair and shake your ankles out for about 10 seconds. Next, gently rotate your ankles clockwise five times then repeat the motion counter-clockwise.
Walking on your toes: Walk barefoot on your toes for four sets of about 15 seconds at a time. Do the exercise at least twice daily.
The pencil lift: Place a pencil on the floor, and pick it up with your toes and hold it for about eight seconds. Relax and repeat the exercise six times. Do this three times each day.
Heel walking: This exercise issimilar to walking on your toes, only this time you walk barefoot on your heels. Again, do four sets of 15 seconds, twice daily.
Sitting calf and heel stretch: This exercise helps toloosen tight leg muscles. Sit down with the knee straight, and put a towel around the ball of the foot affected with tarsal tunnel syndrome. Next, slowly pull the towel back until your stretch your upper calf. Hold for 20 seconds, release, and relax for 10 seconds.
Standing calf and heel stretch: Put your hands on the wall, and place your affected foot behind the other one as you point the toes forward. Keep your back leg straight while slowly bending the front leg until you feel the calf stretch in the back leg. Hold for 20 seconds, then relax for 10 seconds.
Complications of Tarsal Tunnel Syndrome
Several complications of tarsal tunnel syndrome can arise due to the anatomy of the region, which can lead to tarsal tunnel release surgery if the patient doesn’t respond to nonsurgical methods. Some of these complications include deformity of the foot, and partial or complete loss of movement or sensation in the toes. Potential surgical complications related to tarsal tunnel release pertain to the failure to relieve the symptoms; in fact, symptoms may even become worse. Also, operating around the posterior tibial nerve may lead to postoperative bleeding or scarring. Other complications related to tarsal tunnel release surgery include infections, wound healing issues, pulmonary embolisms, complex regional pain syndrome, and deep vein thrombosis.
Preventing Tarsal Tunnel Syndrome
There are several ways to prevent tarsal tunnel syndrome. For example, wearing larger or looser footwear, or properly fitted shoes, can help reduce pain or tightness. Resting and staying off your feet will also help, as this encourages healing and can prevent further injury. Keeping the foot elevated is another good option, because it will take pressure off the foot and will improve circulation. It’s important to avoid walking or standing for long periods of time. Sitting down or changing positions will help relieve stress on the tibial nerve and tarsal tunnel.
Lifestyle Changes for Tarsal Tunnel Syndrome
A number of lifestyle changes can also help prevent and treat tarsal tunnel syndrome, such as:
- Avoiding saturated fat, which is thought to slow circulation in the body and can harm the central nervous system;
- Drinking plenty of green vegetable juices to help reduce inflammation (green leafy vegetables are also a good source of vitamin B6 and other nutrients);
- Drinking a glass of water every two hours (the general recommendation is eight to 10 glasses of water per day);
- Quitting smoking and avoiding secondhand smoke, because both cigarette smoke and cigar smoke can disturb circulation; and
- Undergoing reflexology, which can also help reduce swelling and inflammation by working the areas that correspond to the kidneys, adrenals, and lymph system.
You can also try hydrotherapy, which can provide pain relief and improve blood flow in the ankles and feet. To do this, submerge your feet and ankles in hot water for a couple of minutes, then put them in cold water for approximately 30 seconds. Repeat this method several times for relief.
Sources for Today’s Article:
Balch, J., et al., Prescription for Natural Cures: A Self-Care Guide for Treating Health Problems with Natural Remedies Including Diet, Nutrition, Supplements, and Other Holistic Methods (Hoboken: John Wiley & Sons, Inc., 2004), 142–146.
Aspinwall, M., “Homeopathy and Tarsal Tunnel Syndrome,” Homeopathy World web site, December 8, 2013; http://www.homeopathyworld.com/blog/homeopathy-and-tarsal-tunnel-syndrome/, last accessed March 30, 2016.
“Tarsal Tunnel Syndrome,” Stretch Coach web site; http://stretchcoach.com/articles/tarsal-tunnel-syndrome/, last accessed March 30, 2016.
“Tarsal Tunnel Syndrome,” Foot Health Facts web site; http://www.foothealthfacts.org/footankleinfo/tarsal-tunnel-syndrome.htm, last accessed March 30, 2016.
“Tarsal Tunnel Syndrome and Massage Therapy,” Message by Ben web site, May 30, 2013; http://www.massagebyben.com/articles/articledetail.php?artid=259&catid=265.
“Tarsal Tunnel Syndrome,” Foot Education web site; http://www.footeducation.com/foot-and-ankle-conditions/tarsal-tunnel-syndrome/, last accessed March 30, 2016.
“Tarsal Tunnel Syndrome,” New Health Guide web site; http://www.newhealthguide.org/Tarsal-Tunnel-Syndrome-Treatment.html, last accessed March 30, 2016.
“Tarsal Tunnel Syndrome,” National Organization for Rare Disorders web site; http://rarediseases.org/rare-diseases/tarsal-tunnel-syndrome/, last accessed March 30, 2016.
“Tarsal Tunnel Syndrome,” Johns Hopkins Medicine web site; http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/peripheral_nerve_surgery/conditions/tarsal-tunnel-syndrome.html, last accessed March 30, 2016.
“Tarsal Tunnel Syndrome,” Merck Manual Profession Version web site, last updated October 2014; https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/foot-and-ankle-disorders/tarsal-tunnel-syndrome, last accessed March 30, 2016.