Welcome to Momentum Health's patient resource about Tarsal Tunnel Syndrome.
Tarsal tunnel syndrome is a condition that occurs from abnormal pressure on a nerve in the foot. The condition is similar to carpal tunnel syndrome in the wrist. The condition is somewhat uncommon and can be difficult to diagnose.
This guide will help you understand:
where the tarsal tunnel is located
how tarsal tunnel syndrome develops
what can be done to treat the condition
Hear from some of our Foot Therapy patients
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Sprained my ankle while playing soccer. Got the best treatment from the best physios Mark Taylor and Sofia. They were patient enough to answer all my dumb questions. Also want to mention about the... ”
“ Sprained my ankle while playing soccer. Got the best treatment from the best physios Mark Taylor and Sofia. They were patient enough to answer all my dumb questions. Also want to mention about the lady at the front desk who was really kind. Overall, received the treatment that I was looking for and people are amazing! Highly recommend, would give 6/5 stars. ”
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My wife and I are very selective customers of about everything. If we spend money in today's world, we should get a top and customer-oriented service. The same goes for accessing physiotherapy and... ”
“ My wife and I are very selective customers of about everything. If we spend money in today's world, we should get a top and customer-oriented service. The same goes for accessing physiotherapy and other rehabilitation services after a trauma or a motor vehicle accident. I had never experienced good at other physiotherapists' clinics before. Most clinics are more interested in your insurance money than their patients' complete recovery. I can be biased, but it is my personal opinion. I was very apprehensive in my search for a professional physiotherapy center. I Google-searched for nearly two days and read lots of reviews. I narrowed my search and selected Momentum Health at Deerfoot and 64th Avenue, NE. I can say my hrs. long search was not in vain. The treatment is top-notch and very professional in medical and customer services. I highly recommend this clinic for any massage, physiotherapy, or related service. My physiotherapist, Mark Taylor, Kinesiologist, Safia, and massagist, Meagan, are professional and sincere healthcare professionals. They go beyond and above to help you with your problem. They listen to you and then advise accordingly. I highly recommend this clinic and those individuals I dealt with. It is worth your money, time, and energy to give them a chance and try their positive, effective, and professional service. I will go back to them for sure again if another occasion arises. ”
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I recently saw Joel for an ankle injury. He was professional, empathetic and really helped me understand my limits. I really felt comfortable with his IMS techniques and I felt a lot of relief... ”
“ I recently saw Joel for an ankle injury. He was professional, empathetic and really helped me understand my limits. I really felt comfortable with his IMS techniques and I felt a lot of relief following! One could say he has ‘magic hands’. 5/5 service! ”
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Just had an amazing deep tissue massage from Christina. Walked in with major foot pain. Told her exactly where it hurt. She messaged the area and listened to me if it hurt too much. She then worked on... ”
“ Just had an amazing deep tissue massage from Christina. Walked in with major foot pain. Told her exactly where it hurt. She messaged the area and listened to me if it hurt too much. She then worked on areas she thought would help my foot and it worked. I got up from the table and could walk without pain. The deep tissue massage was perfect. She kept asking if the pressure was good or too much and acted accordingly to my answer. There’s a reason she books so far out. She’s that good. Extremely happy to have found Christina. I would highly recommend her to anyone ”
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Rebecca and Karissa have helped me immensely in recovery from a ruptured achilles tendon. Their guidance and program has helped me heal and strengthen the injury. Top notch quality and care from the... ”
“ Rebecca and Karissa have helped me immensely in recovery from a ruptured achilles tendon. Their guidance and program has helped me heal and strengthen the injury. Top notch quality and care from the best people. Thanks for everything! ”
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I have been a client of Brad Fugimoto for several years and when I developed a sore heel (plantar fasciitis ), I asked him about it. He found that my calf muscle was very tight and said if I could... ”
“ I have been a client of Brad Fugimoto for several years and when I developed a sore heel (plantar fasciitis ), I asked him about it. He found that my calf muscle was very tight and said if I could tolerate deep massage of it, the heel pain would likely resolve. However I didn't think I could tolerate it so decided to try other practitioners, including seeing a podiatrist for new orthotics, another chiropractor for Cold Laser, a Physiotherapist for Ultrasound and Acupuncture , plus doing many prescribed exercises. The pain persisted. So I saw my Homeopath/RN for her opinion. She diagnosed it as a muscle/fascia problem of the lower leg which caused the inflammation in the plantar fascia (heel). Bingo! She recommended a technique called Myofascial Release. This is the same as what Brad had described 3 months ago. So back to Brad I went and after one treatment (which was painful), the heel pain is relieved about 50% and hopefully a few more treatments will bring it back to normal. I very much recommend Brad Fugimoto for his expertise, professionalism and his intuitive ability. ”
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Mark, our physiotherapist was absolutely amazing!! My son sprained his ankle playing sports and months later it was still bothering him to the point he couldn’t play for his competitive soccer team... ”
“ Mark, our physiotherapist was absolutely amazing!! My son sprained his ankle playing sports and months later it was still bothering him to the point he couldn’t play for his competitive soccer team anymore. Mark spent time with him on a weekly basis for a few weeks and drew up a plan for him to also work on his ankle at home and now he is 100% pain free!! Mark made my shy son feel comfortable during his visits and helped him so much! Even on our last visit, my son had strained his neck sleeping awkwardly one night and one visit with Mark fixed him right up! I highly recommend Momentum Health Deerfoot! Thanks so much to Mark and the very friendly reception staff who always made our visits enjoyable! ”
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Good morning i have been having nerve problems and numbness in my left leg hip and ankle, since i have been coming there i have been treated with respect and kindness for my problem, i feel very... ”
“ Good morning i have been having nerve problems and numbness in my left leg hip and ankle, since i have been coming there i have been treated with respect and kindness for my problem, i feel very confident that the team there will help me to get better if possible. Russ is awesum he has done things that no other physio place has tried i believe he accutually cares about my injury and healing process. Hats off to all of you i would recommend treatment here for anyone who has issues with your body. ”
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I have been working with Mark Taylor to help remidy my ankle tendonitis for a couple months now, already seeing massive improvements and very little pain anymore. Would recommend. ”
“ I have been working with Mark Taylor to help remidy my ankle tendonitis for a couple months now, already seeing massive improvements and very little pain anymore. Would recommend. ”
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I've been coming here for a few months. My foot got crushed in forklift incident at the company I was working for and I've been having to learn how to walk on the for again. So far my experience has... ”
“ I've been coming here for a few months. My foot got crushed in forklift incident at the company I was working for and I've been having to learn how to walk on the for again. So far my experience has been positive with Mark being easy to talk to and not overbearing or aggressive. The current negative is that finding the location is hard due to the set up of the mall, but that is the fault of the overseers Shape Properties not knowing how to do competent address designation. ”
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I had an inflamed Achilles’ tendon after rolling my ankle during a winter run. I could barely walk. Amy diagnosed the problem and gave me treatment and exercises that set me right. She focused on... ”
“ I had an inflamed Achilles’ tendon after rolling my ankle during a winter run. I could barely walk. Amy diagnosed the problem and gave me treatment and exercises that set me right. She focused on strengthening my ankle so the problem would not re-occur and stretching to address muscle tightness. The team at Momentum West Springs is my first choice whenever I have an injury. I trust them to get me back fast. Thanks Amy and Nicole! ”
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My first trip to Momentum Health Ogden today had me meeting with Meghan Murphy for physio for my Achilles Tendonitis. She was thorough, knowledgeable and thoughtful of my pain tolerance. I’m... ”
“ My first trip to Momentum Health Ogden today had me meeting with Meghan Murphy for physio for my Achilles Tendonitis. She was thorough, knowledgeable and thoughtful of my pain tolerance. I’m confident in the regimen she’s laid out for my recovery and highly recommend her to help you work through any injuries you may have! ”
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Kaylie and Rachel were absolutely phenomenal in getting me back to life and mobile. I came in with a serious ankle sprain and developed a secondary sprain on my other ankle, too. They worked... ”
“ Kaylie and Rachel were absolutely phenomenal in getting me back to life and mobile. I came in with a serious ankle sprain and developed a secondary sprain on my other ankle, too. They worked diligently with me to make sure I was progressing in my healing process and are both extremely friendly. I would highly recommend Momentum Health and Rachel and Kaylie if you are in need of physiotherapy treatment! ”
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Kaylie and Rachel were an amazing team helping to heal my foot. They were super knowledgeable about the body and friendly to chat with during each session. Thanks so much for the help!!! ”
“ Kaylie and Rachel were an amazing team helping to heal my foot. They were super knowledgeable about the body and friendly to chat with during each session. Thanks so much for the help!!! ”
The tibial nerve runs into the foot behind the medial malleolus, the bump on the inside of the ankle. As it enters the foot, the nerve runs under a band of fibrous tissue called the flexor retinaculum. The flexor retinaculum is a dense band of fibrous tissue that forms a sort of tunnel, or tube. Several tendons, as well as the nerve, artery, and veins that travel to the bottom of the foot pass through this tunnel. This tunnel is called the tarsal tunnel. The tarsal tunnel is made up of the bone of the ankle on one side and the thick band of the flexor retinaculum on the other side.
In many cases, doctors aren't sure what causes tarsal tunnel syndrome. Inflammation in the tissues around the tibial nerve may contribute to the problem by causing swelling in the tissues and pressure on the nerve.
Anything that takes up space in the tarsal tunnel can increase pressure in the area because the flexor retinaculum cannot stretch very much. This can occur from swollen varicose veins, a tumor (noncancerous) on the tibial nerve, and swelling caused by other conditions, such as diabetes.
As pressure increases in the tarsal tunnel, the nerve is the most sensitive to the pressure and is squeezed against the flexor retinaculum.
This causes problems in the nerve that may lead to symptoms of tarsal tunnel syndrome.
Tunnel Syndrome Symptons
In the case of a nerve, the area of skin supplied by the nerve usually feels numb, and the muscles controlled by the nerve may become weak. Pain is sometimes felt near the area where the nerve is squeezed or pinched.
Symptoms
What does tarsal tunnel syndrome feel like?
Tarsal tunnel syndrome usually causes a vague pain in the sole of the foot. Most patients describe this pain as a burning or tingling sensation. The symptoms are typically made worse by activity, especially standing and walking for long periods. Symptoms are generally reduced by rest. You may feel pain if you touch your foot along the course of the nerve. If the condition becomes worse, your foot may feel numb and weak.
Diagnosis
How do health care providers identify tarsal tunnel syndrome?
When you first visit Momentum Health in Calgary our physiotherapist will begin by taking a complete history, and will perform a physical examination. We will also check to see if there are any signs that suggest nerve involvement.
Some patients may be referred to a doctor for further diagnosis. Once your diagnostic examination is complete, the physiotherapists at Momentum Health have treatment options that will help speed your recovery, so that you can more quickly return to your active lifestyle.
Our Treatment
Non-surgical Rehabilitation
Treatment for this condition depends on what is contributing to the pressure on the nerve. Our physiotherapist can direct treatments to the painful area that help to control pain and swelling, such as ultrasound, moist heat, and soft-tissue massage. Physiotherapy sessions sometimes include iontophoresis, which uses a mild electrical current to push anti-inflammatory medicine, prescribed by your doctor, into the sore area.
Once the swelling and inflammation have improved, our physiotherapist can design a program of stretching exercises to improve flexibility in the calf muscles and to encourage the tibial nerve to glide within the tarsal tunnel.
People who have problems ofpronation (flattened arches) may need specialized inserts, called orthotics, for their shoes.
Pronation is a common condition in which the inside edge of the foot rolls in, causing the arch to flatten. When this happens, the tibial nerve within the tarsal tunnel can become stretched.
If your tarsal tunnel syndrome is being aggravated by an abnormal position of the foot such as pronation, our physiotherapist may recommend orthotics to relieve the problem. Orthotics worn inside your shoe can help support the arch and take tension off the tibial nerve.
Orthotics
If your symptoms fail to respond to nonsurgical treatments, surgery to relieve the pressure on the tibial nerve may be suggested.
Post-surgical Rehabilitation
Pain and symptoms generally begin to improve with surgery, but you may have tenderness in the area of the incision for several months after the procedure.
Your ankle will be supported in a plaster splint for about 10 days after surgery. To help you begin your recovery, the physiotherapists at Momentum Health in can teach you how to properly use crutches to keep from placing weight on your foot while you stand or walk.
You will be advised to keep the dressing on your foot until you return to your doctor for follow up, and to avoid getting the stitches wet. Your stitches will usually be removed 10 days after surgery, at which time you will switch to a supportive walking boot.
Your physiotherapist in Calgary will advise you to take time during the day to support your leg with the ankle and foot elevated above the level of your heart to promote the decrease of swelling. You will also be encouraged you to move your ankle and toes occasionally during the day.
Our physiotherapist may use ice packs, soft-tissue massage, and hands-on stretching to help with the range of motion in your ankle. When your stitches are removed, you'll begin doing exercises to help strengthen the muscles that support the ankle and arch. We may also use special stretches to encourage the tibial nerve to slide inside the tarsal tunnel.
When you are ready, our physiotherapist will provide you with new exercises designed to get your leg and ankle working in ways that are similar to the activities you do every day, such as rising on your toes, walking, and going up and down stairs.
Although the time required for recovery is different for each person, as a guideline you may expect to attend physiotherapy sessions for up to eight weeks after surgery, with full recovery taking several months.
When your recovery is well under way, your regular visits to Momentum Health will end. Although we will continue to be a resource, you’ll eventually be in charge of doing your exercises as part of an ongoing home program.
Momentum Health provides services for physiotherapy in Calgary.
Physician Review
Your doctor may advise doing a nerve conduction velocity (NCV) test to help diagnose your condition. This test measures how fast nerve impulses travel along a nerve. If the test shows that the impulses are traveling slowly across the ankle, this may confirm a diagnosis of tarsal tunnel syndrome.
If your doctor recommends nonsurgical treatment, you should begin to see some improvement in your symptoms within a few days. Anti-inflammatory medications may take up to seven to 10 days to become effective.
A cortisone shot usually works within 24 hours. A cortisone injection may give temporary relief of symptoms. The cortisone is injected into the tarsal tunnel so that it bathes the nerve and other tissues. This may decrease the inflammation and swelling of the tissues in the tarsal tunnel and reduce the irritation on the nerve.
Alterations to your shoe wear, such as using orthotics, may take several weeks to have an effect.
Surgery
The procedure to release the flexor retinaculum can usually be done using either a spinal type anesthetic or a general anesthetic. Once you have anesthesia, your surgeon will make sure the skin of your leg and ankle are free of infection by cleaning the skin with a germ-killing solution.
The surgeon then makes a small incision in the skin behind the inside ankle bone (medial malleolus). The incision is made along the course of the tibial nerve where it curves behind the malleolus. The nerve is located and released by cutting the flexor retinaculum. The surgeon will then surgically follow the nerve into the foot, making sure the nerve is free of pressure throughout its course.
The flexor retinaculum is left open to give the nerves more space. Eventually, the gap between the two ends of the flexor retinaculum fills in with scar tissue. Following surgery, the skin is repaired with stitches.
This surgery can usually be done on an outpatient basis, meaning you can leave the hospital the same day.
In many cases, doctors aren't sure what causes tarsal tunnel syndrome. Inflammation in the tissues around the tibial nerve may contribute to the problem by causing swelling in the tissues and pressure on the nerve.
Once the swelling and inflammation have improved, our physiotherapist can design a program of stretching exercises to improve flexibility in the calf muscles and to encourage the tibial nerve to glide within the tarsal tunnel.
