Physical Therapy Guide to Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is a condition that results from abnormal pressure on a nerve on the inside of the ankle. The condition is not common. TTS can cause pain or tingling in the sole of the foot, the heel, or into the toes and the entire foot. It also can lead to weakness of the lower leg and foot. It is often linked to conditions that strain or compress the tibial nerve, such as flat feet, swelling, arthritis, and diabetes. Physical therapists provide treatments to help reduce the compression of the affected nerve. They work with you to help relieve pain and restore normal function.
Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.
What Is Tarsal Tunnel Syndrome?
Often described as the carpal tunnel syndrome of the leg, TTS results from compression of the posterior tibial nerve. This nerve runs through the tarsal tunnel (a structure made up of bone and tissue on the inside of the ankle). As it passes through the tarsal tunnel, the tibial nerve divides into three branches that give feeling to the heel and bottom of the foot, and aid in the foot's function. When compressed, symptoms (such as pain, numbness, and tingling) may occur and radiate into the foot, heel, and/or toes. People also may experience muscle weakness in the area.
How Does It Feel?
The most common symptoms of TTS result from irritation of the tibial nerve and its branches. People with TTS may experience:
- Pain, numbness, or tingling in the sole of the foot or the ankle, which may radiate into the foot, heel, and toes.
- Weakness in the muscles of the lower leg and foot.
- Weakness of the big toe.
- Foot swelling.
- Symptoms that increase with prolonged standing or walking.
- Symptoms that improve with rest.
- Increased sense of cold or warmth of the foot and ankle.
- Pain that disrupts sleep.
How Is It Diagnosed?
There are several tests that can help a clinician determine if TTS is present. Your physical therapist and/or physician will first take a complete health history, and ask about your current symptoms. They may conduct tests, such as:
- Gently tapping over the posterior tibial nerve to try to reproduce your symptoms.
- “Tensioning” of the posterior tibial nerve — a maneuver that looks and feels like a stretch — to try to reproduce symptoms.
- A nerve conduction study — a diagnostic test to determine the speed at which a nerve conducts information.
Tests to rule out other conditions such as plantar fasciitis (inflammation of the tissue that runs along the bottom of the foot).
How Can a Physical Therapist Help?
Physical therapists play a vital role in helping people experiencing TTS to improve and maintain their daily function and activities. Treatment for TTS will depend on what is contributing to the pressure on your posterior tibial nerve. Your physical therapist will work with you to develop a treatment plan to help address your specific needs and goals.
Because the signs and symptoms of TTS can vary, the approach to care will also vary. Your physical therapist may provide the following recommendations and care:
Nerve gliding. Gentle exercises that move and "glide" the nerves may help reduce symptoms and improve function.
Muscle strengthening and flexibility training. Certain exercises can address any muscle weakness or tightness that could contribute to TTS, or that may result from it. Some treatments may be focused on the knee and hip as well as the foot and ankle. Your physical therapist will choose the right regimen to address your specific needs.
Manual therapy. Your physical therapist may recommend manual (hands-on) therapy to gently move your foot and surrounding muscles. These techniques, which may be hard to do on your own, will help reduce pain and restore movement to areas around the foot.
Balance and coordination activities. Your physical therapist will work with you to improve your balance and coordination, which are often affected by TTS.
Orthotics/taping/bracing. Your physical therapist may apply ankle taping, a custom orthotic, or bracing to position the foot to decrease stress on the posterior tibial nerve.
Education. As with many conditions, education is key. Your physical therapist will help you understand the underlying causes of TTS. Learning to recognize early signs and symptoms may help you better manage the condition.
The goals of physical therapy are to reduce pain, improve movement, strength, flexibility, and endurance, and help you get back to doing the things that you need or love to do.
Can This Injury or Condition Be Prevented?
Although there are no proven ways to prevent TTS, there are ways to minimize stress to the foot and ankle. These include:
- Choosing appropriate footwear.
- Wearing orthotics to support your arch.
- Minimizing the amount of time spent standing on hard surfaces.
- Improving and maintaining strength in the muscles of your legs, ankles, and feet.
These strategies can be discussed further with your physical therapist.
In addition, detecting the signs and symptoms of TTS and addressing them early will help you and your medical providers begin appropriate management of the condition, which may enhance your long-term well-being.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat various conditions, such as tarsal tunnel syndrome. However, when seeking a provider, you may want to consider:
- A physical therapist who has experience working with people with TTS. Some physical therapists have a practice with an orthopedic focus.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can search for physical therapists in your area who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family, friends, or other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with TTS.
Be prepared to describe your symptoms in as much detail as possible.
The American Physical Therapy Association believes that consumers should have access to information that can:
- Help them make health care decisions.
- Prepare them for a visit with their health care provider.
The following articles provide some of the best scientific evidence for the treatment of TTS. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to the free full text, so that you can read it or print out a copy to bring with you to your health care provider.
McSweeney SC, Cichero M. Tarsal tunnel syndrome: a narrative literature review. Foot (Edinb). 2015;25(4):244–250. Article Summary on PubMed.
Lareau CR, Sawyer GA, Wang JH, DiGiovanni CW. Plantar and medial heel pain: diagnosis and management. J Am Acad Orthop Surg. 2014;22(6):372–380. Article Summary on PubMed.
Alshama AM, Souvlis T, Coppieters MW. A review of plantar heel pain of neural origin: differential diagnosis and management. Man Ther. 2008;13(2):103–111. Article Summary on PubMed.
*PubMed is a free online resource developed by the National Center for Biotechnology Information. PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.