The tarsal tunnel is located on the inside of the ankle, and is formed by the ankle bones and the band of ligaments that stretches across the foot. Many of the blood vessels, nerves and tendons that provide movement and flexibility to the foot travel through the tarsal tunnel.

Tarsal tunnel syndrome (TTS) is caused by compression of the posterior tibial nerve as it travels through the tarsal tunnel. Compression of the posterior tibial nerve can cause pain, tingling or numbness in the foot.

TTS may be caused by any condition that strains or compresses the tibial nerve, including:

• Flat feet or fallen arches

• Swelling caused by an ankle sprain

• Diseases such as arthritis or diabetes, which can cause swelling and nerve compression

• A varicose vein, ganglion cyst, swollen tendon or bone spur

TTS Diagnosis

Proper diagnosis of TTS requires the expert attention of experienced neurologists and nerve specialists. It is important that the doctor determine the severity of the condition in order to recommend the most appropriate treatment plan, including surgery, if necessary.

A diagnostic workup for TTS may involve:

• A comprehensive clinical exam

• Complete medical history

• Electrical testing (EMG or nerve conduction study)

• Imaging (X-rays, CT scan or MRI)

TTS Treatment

Nonsurgical treatment for TTS includes anti-inflammatory medications or steroid injections into the tarsal tunnel to relieve pressure and swelling. Braces, splints or other orthotic devices may help reduce pressure on the foot and limit movement that could cause compression on the nerve.

Depending on the severity of the condition, the doctor may ultimately recommend one of several surgical procedures to address the problem, including an operation called tarsal tunnel release.

In tarsal tunnel release, the surgeon creates an opening behind the ankle that extends down to the arch of the foot. The surgeon carefully divides the ligament so it is not pressing against the tibial nerve.