Is My Heel Pain Caused by Tarsal Tunnel Syndrome?

Heel pain can be a distressing issue, and while it’s often associated with conditions like plantar fasciitis or heel spurs, tarsal tunnel syndrome (TTS) is another potential culprit that can cause discomfort in the heel area.

Causes of Tarsal Tunnel Syndrome

Tarsal tunnel syndrome occurs when the posterior tibial nerve, which runs along the inside of the ankle and into the foot through a narrow passage called the tarsal tunnel, becomes compressed or irritated. This compression can happen due to various reasons, such as:

• Flat Feet or Fallen Arches: When the arch of the foot collapses, it can put pressure on the nerve within the tarsal tunnel, leading to irritation or compression.
• Injuries or Trauma: Ankle sprains, fractures or other injuries can cause swelling or inflammation in the tarsal tunnel, compressing the nerve.
• Systemic Conditions: Health issues like diabetes arthritis or hypothyroidism can contribute to nerve compression and increase the risk of developing tarsal tunnel syndrome.

Many causes of TTS occur over years of changes to the structures in the ankle and foot. Individuals with this condition may not realize they have the disorder until symptoms become worse.

TTS Symptoms

The symptoms of tarsal tunnel syndrome often manifest in the foot, ankle and heel region, resembling other foot conditions, making diagnosis challenging. Common signs include:

• Pain: Individuals with TTS may experience a burning or shooting pain in the heel or sole of the foot. The pain might worsen with activity and improve with rest.
• Tingling or Numbness: Numbness, tingling sensations, or a pins-and-needles feeling in the heel or toes are common symptoms of nerve compression associated with tarsal tunnel syndrome.
• Weakness: Some people may notice weakness in the foot or toes, making it challenging to perform certain movements.
• Radiating Pain: Pain or discomfort might radiate along the path of the nerve, extending from the inside of the ankle down to the arch or heel of the foot.

Symptoms may come and go, which can also make diagnosis difficult. Typically, patients may have had signs and symptoms of TTS for months or years before they finally receive a diagnosis and have treatment options available.

Treatments for Tarsal Tunnel Syndrome

Initially, resting the foot and avoiding activities that exacerbate symptoms can help alleviate pain. Immobilization through the use of a brace or splint might also be recommended to reduce pressure on the nerve. When rest alone is not enough, the following treatments may be recommended:

• Physical Therapy: Specific exercises aimed at stretching and strengthening the foot and ankle can help alleviate symptoms and prevent further nerve compression.
• Orthotic Devices: Custom-made or supportive shoe inserts can provide better arch support and help redistribute pressure, reducing nerve compression.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or pain relievers may be prescribed to manage pain and inflammation associated with tarsal tunnel syndrome.
• Steroid Injections: In some cases, corticosteroid injections into the tarsal tunnel can help reduce inflammation and alleviate symptoms.
• Surgery: If conservative treatments fail to provide relief, surgery might be considered. The surgical procedure aims to decompress the nerve by releasing any constricting structures within the tarsal tunnel.

Diagnosing tarsal tunnel syndrome typically involves a thorough physical examination, possibly followed by imaging tests like MRI or nerve conduction studies to assess nerve function and identify potential causes of compression.

If you are experiencing persistent heel pain or symptoms resembling those associated with tarsal tunnel syndrome, it is crucial to consult with a foot specialist for proper evaluation and treatment recommendations tailored to your specific condition. Stuart J. Mogul, DPM, FACFAS, is the foot surgeon that professional dancers and athletes trust when they are experiencing foot conditions. Call our office in NYC to schedule a consultation with Dr. Mogul if you suspect that you are experiencing tarsal tunnel syndrome.