You’ve heard of carpel tunnel syndrome, right? In case you haven’t, it consists of pain in the wrist that is most commonly seen in tennis players. Well, I’d like you to meet carpel tunnel’s less well-known cousin, tarsal tunnel syndrome, which impacts the foot.

Often called ‘carpel tunnel of the foot,’ tarsal tunnel syndrome occurs when the posterior tibial nerve, which runs through the tarsal tunnel behind the bony bump on the inside of the ankle, is compressed and therefore irritated. Any activity that repetitively requires the inside of the sole of the foot to be weight bearing, such as long-distance running and cycling, can cause inflammation of the tarsal tunnel. A variety of other factors can also cause problems, such as benign tumors, varicose veins, bone spurs, and post-traumatic adhesion (immobilization intended to heal a fracture or sprain causes the nerve to attach itself to another structure to which it is not supposed to be attached). Basically, the nerve doesn’t have the space it needs, so it becomes irritated and consequently irritates the person whose foot it occupies.

This irritation can include sensations such as burning, tingling and a zinging pain on the bottom of the heel, and sometimes slight numbness in the toes. With tarsal tunnel syndrome, the patient usually experiences tenderness directly over the posterior tibial nerve, which helps to distinguish it from other nerve entrapment syndromes.

There are both operative and non-operative means of treating tarsal tunnel syndrome. A heel wedge placed on the inside of the heel decreases tension on the nerve and can provide relief. A steroid injection into the tarsal tunnel can be helpful but will often bring only temporary ease of symptoms. Especially in athletes, surgical release of the nerve and removal of any tumors or spurs can become necessary for pain relief. If surgery is the only option to alleviate the pain, a qualified orthopedic foot surgeon will speak with you and select the appropriate procedure or procedures based on your individual situation and condition.

– David A. Porter M.D. PhD

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