Treatment for Tarsal Tunnel Syndrome

Types of Tarsal Tunnel Syndrome

Understanding the condition's origin helps our physiotherapists create the most effective and personalised treatment plan. The cause of the nerve compression is the primary factor used to categorise the syndrome into several distinct types.

Idiopathic Tarsal Tunnel Syndrome

In a significant number of cases, a specific, identifiable cause for the tibial nerve compression cannot be found. These instances are classified as "idiopathic." The characteristic symptoms of pain or numbness appear spontaneously, without any preceding injury, diagnosed structural abnormality, or systemic disease that could readily explain the pressure on the nerve. Management in these situations focuses purely on symptom relief and biomechanical improvements.

Traumatic Tarsal Tunnel Syndrome

This type is a direct consequence of an injury to the ankle region. A common incident like an ankle sprain, a fracture, or even a blunt force impact can trigger immediate swelling and inflammation within the confined space of the tarsal tunnel, leading to nerve compression. Furthermore, scar tissue that forms during the healing process can eventually constrict the tunnel, causing delayed onset of symptoms long after the initial trauma.

Lesion-Induced Tarsal Tunnel Syndrome

Nerve compression can be caused by various space-occupying lesions that develop within or adjacent to the tarsal tunnel. Common culprits include ganglion cysts (fluid-filled sacs), varicose veins, benign tumours such as lipomas or fibromas, or swollen and inflamed tendons (tendonitis). Any of these growths or inflamed structures can physically reduce the available space, putting direct and consistent pressure on the tibial nerve.

Systemic Disease-Related Tarsal Tunnel Syndrome

Certain widespread medical conditions are known contributors to the development of this syndrome. Diseases such as diabetes, which can affect nerve health, and inflammatory conditions like rheumatoid or osteoarthritis can cause generalised fluid retention and inflammation throughout the body. This systemic swelling can affect the ankles, leading to secondary nerve compression within the tarsal tunnel and requiring a dual approach to treatment.

The Diagnosis Process for Tarsal Tunnel Syndrome

An accurate Tarsal Tunnel Syndrome diagnosis is essential to distinguish it from similar conditions like plantar fasciitis or lumbar radiculopathy. A physiotherapist or physician will employ a combination of detailed clinical evaluation and advanced diagnostic tests.

Physical Examination and History

The diagnostic process invariably starts with a comprehensive review of your medical history and a detailed discussion about your symptoms—their nature, location, and triggers. Your healthcare provider will then conduct a focused physical exam, which critically includes Tinel’s test. This involves gently tapping over the posterior tibial nerve at the inner ankle. A positive test, which reproduces the tingling, numbness, or shooting pain, is a strong clinical indicator of the syndrome.

Nerve Conduction Velocity (NCV) Studies

This is considered a definitive tarsal tunnel syndrome test. It precisely measures the speed and strength at which electrical impulses travel along the nerve. Electrodes are placed on the skin over the tibial nerve at various points, and a mild electrical current is delivered. A noticeable slowing of this signal as it passes through the tarsal tunnel is clear evidence of nerve compression.

Electromyography (EMG)

Often conducted in conjunction with NCV studies, an EMG test evaluates the electrical activity and health of the muscles that the tibial nerve controls. This test involves inserting very fine needle electrodes into specific foot muscles to record their activity both at rest and during contraction. Abnormal Tarsal Tunnel Syndrome test results from an EMG can confirm if the nerve compression has led to muscle damage.

Imaging Tests

While not used to diagnose the nerve compression itself, imaging tests for Tarsal Tunnel Syndrome are invaluable for identifying the root cause of the pressure. An MRI scan is excellent for visualising soft tissues and can reveal lesions like cysts, tumours, or tendonitis. An X-ray is useful for identifying bony issues, such as fractures or bone spurs, that might be encroaching on the tunnel.

Treatment and Management of Tarsal Tunnel Syndrome

The primary objective of treatment for Tarsal Tunnel Syndrome is to decompress the tibial nerve, alleviate symptoms, and restore function. The therapeutic approach is typically conservative at first, escalating only if necessary.

The RICE Method

For managing acute symptom flare-ups, the RICE protocol- Rest, Ice, Compression, and Elevation—is a highly effective first line of defence. Resting the foot avoids further irritation, applying ice for 15-20 minutes reduces inflammation, using a compression wrap minimises swelling, and elevating the leg above heart level helps drain excess fluid from the ankle area.

Medications and Injections

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can be effective in reducing both pain and inflammation. For more persistent or severe cases, your doctor may suggest a corticosteroid injection. This powerful anti-inflammatory medication is administered directly into the tarsal tunnel to rapidly decrease swelling around the nerve and provide significant, albeit sometimes temporary, relief.

The Core Role of Rehabilitation

Rehabilitation is the cornerstone of successful long-term Management of Tarsal Tunnel Syndrome. A structured program designed by a physiotherapist addresses the fundamental causes of nerve compression, works to improve foot and ankle mechanics, strengthens supporting musculature, and helps prevent the condition from recurring. This is where specialized, hands-on therapies truly make a difference in achieving a complete recovery.

Surgical Decompression

If a comprehensive course of conservative treatments fails to provide adequate relief after several months, surgical intervention may be considered. The standard procedure, known as a tarsal tunnel release, involves an incision to cut the flexor retinaculum (the ligament forming the tunnel's roof). This action creates more space, immediately releasing pressure on the tibial nerve and allowing it to function normally again.

How Physical Therapy Transforms Tarsal Tunnel Syndrome Recovery

Tarsal tunnel syndrome physical therapy is a powerful, non-invasive treatment that focuses on resolving both the symptoms and the underlying biomechanical faults. A skilled physiotherapist at Physiotattva will develop a customised Tarsal Tunnel Syndrome rehabilitation plan tailored to your specific needs.

Manual Therapy Techniques

Hands-on treatment is central to physical therapy for Tarsal Tunnel Syndrome. Our therapists employ targeted soft tissue massage and myofascial release to reduce inflammation, break down adhesions, and release tight muscles around the ankle. They also use gentle joint mobilisation techniques to improve the mobility of the ankle and foot joints, directly helping to decompress the tibial nerve and restore healthy movement.

Nerve Gliding Exercises

These are specialized, gentle movements designed to help the tibial nerve slide or "glide" more freely within the tarsal tunnel. By carefully and repeatedly moving the foot and ankle through a specific range of motion, these exercises act like flossing for the nerve. This helps to break down minor scar tissue or adhesions that may be restricting its path, improving nerve health and reducing irritation.

Strengthening and Stretching Programs

Muscle imbalances, such as weakness in the intrinsic foot muscles or tightness in the calf muscles, can lead to poor biomechanics and increased strain on the tarsal tunnel. Your physiotherapist will prescribe a targeted exercise regimen to strengthen key stabilising muscles in the foot and lower leg while stretching tight structures like the calf and plantar fascia, creating better overall support and alignment.

Biomechanical Correction and Orthotics

An abnormal foot posture, particularly overpronation or "flat feet," is a common contributor to this condition. A physical therapist will perform a detailed gait analysis to assess how you walk and stand. Based on this, they may recommend custom orthotic inserts for your shoes. These devices correct poor foot alignment, redistribute pressure away from the inner ankle, and provide crucial support to reduce strain on the nerve. The recovery timeline for Tarsal Tunnel Syndrome is often significantly improved with proper biomechanical support.

Get Personalised Treatment for Tarsal Tunnel Syndrome at Physiotattva

Tarsal Tunnel Syndrome can be a challenging condition, but with the right treatment approach, it’s highly manageable. The first crucial step is obtaining an accurate diagnosis, which helps guide an effective, personalised treatment plan. Among the various management options, physical therapy stands out as a top non-invasive strategy. It not only helps relieve pain but also addresses the underlying biomechanical and muscular issues contributing to nerve compression, ensuring long-term relief.

At Physiotattva physiotherapy clinics in Bangalore and Hyderabad, you receive personalised care tailored to your specific needs, ensuring effective results and comfort throughout your journey to recovery. 

Don’t wait to start your recovery! Get in touch with Physiotattva for more details! Contact us at +91 89510 47001.