How To Treat Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is similar to carpal tunnel syndrome , which occurs in the wrist. Tarsal tunnel syndrome is a chronic injury caused by compression or squeezing of the nerve that provides sensation to the bottom of your foot,  the posterior tibial nerve.

It is most common in active adults , but can also occur in children.

What Causes Tarsal Tunnel Problems?

It can be several things, usually something else that is taking up space where it shouldn't be. Benign growths of the bone like heel spurs, growths on the nerve like ganglions, swelling from a fracture, a swollen muscle, foot deformity...anything that interferes with the space needed by the nerve. Sometimes no cause is found.



Pain is sometimes felt near the area where the nerve is squeezed or pinched. Pain in the foot can also be caused by ligament and tendon laxity in the knee.

Pain in the feet can be extremely debilitating; it usually starts in the heel with a burning or sharp stabbing sensation.

Conversely you may only experience numbness from nerve compression.


A variety of treatment options, often used in combination, are available to treat tarsal tunnel syndrome. Since foot pain can actually be caused by plantar fasciitis or heel spurs, a diagnosis is in order. That starts with testing the nerve by a specialist to rule out other nerve conditions and to confirm the diagnosis of tarsal tunnel syndrome.

The treatments begin with anti-inflammatory medications , and possibly an injection of cortisone into the area around the nerve. You may also be ordered to get rest, casting with a walker boot, anesthetic injections , hot wax baths , wrapping , and compression hose.

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You may be advised to use orthotics  if there is a biomechanical abnormality.

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If there is a stress fracture, treatment is non-weight bearing in a cast for at least 6 to 8 weeks depending on the severity of the fracture. It is very important to seek early treatment if any of the symptoms of tarsal tunnel syndrome occur. Sometimes surgery is recommended .


Surgery for decompression may be necessary for cases that do not respond to these treatments. Surgery involves making a small incision behind the ankle, along the course of the posterior tibial nerve in order to decrease the pressure..This surgery can usually be done on an outpatient basis , meaning you can leave the hospital the same day.

Your ankle will be supported in a plaster splint for 10 days after surgery.

Your surgeon may have you attend physical therapy sessions for up to eight weeks after surgery.

Tarsal Tunnel Release Protocol

Guidelines only - follow your physician's orders

  • Initial: splint and non-weight bearing minimum two weeks, possibly four weeks
  • One week: post-op boot
  • Two weeks: possibly weight bearing with crutches to assist, begin gently exercising
  • Four weeks: increase exercise, more weight bearing
  • Six weeks: exercise includes increased balance and mobilty; able to bear full weight
  • Eight weeks: endurance (running) is OK; some may be back to full activities


Occasionally, tarsal tunnel syndrome is confused with plantar fasciitis, or heel spurs.

Treatment of the tarsal tunnel syndrome is accomplished by resisting the forces on the tibial nerve. Compared with carpal tunnel syndrome, tarsal tunnel syndrome is much less common. Among the most widely used treatment method for tarsal tunnel syndrome is the use of an orthotic device. Surgery involves decompression of the posteriot tibial nerve followed by Tarsal Tunnel Release Protocol.