Tarsal tunnel syndrome is typically not a medical condition that will go away on its own. If left untreated, it will likely continue to get worse and can lead to permanent nerve damage. If you do get treatment, the recovery time will depend on what treatment is necessary, which itself will depend on the severity and the cause of the injury. If you have a minor case of
tarsal tunnel syndrome or sought treatment quickly after developing it, you can begin to feel relief right away. If you need surgery to correct the condition, the recovery period is generally 4 to 6 weeks.
What is Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome is a medical condition in the interior side of your ankle. The posterior tibial nerve runs down your calf and then behind and below the inside bone of your ankle, which is also known as the medial malleolus. As the tibial nerve goes around the ankle bone, it passes through the tarsal tunnel – a band of ligaments that arch over the posterior tibial nerve, as well as many other blood vessels, nerves, and tendons, and is covered by the flexor retinaculum, which is a ligament that protects the structures. On its way through the tarsal tunnel, the posterior tibial nerve splits into the:
- Medial plantar nerve, which runs towards the inside of your foot
- Lateral plantar nerve, which runs towards the outside of your foot
- Inferior calcaneal nerve, which goes to the bottom of your heel
You suffer tarsal tunnel syndrome, or TTS, if the posterior tibial nerve gets compressed in this passageway. If left untreated, this compression can cause nerve damage. This condition can also be referred to as Posterior Tibial Nerve Neuralgia. Tarsal Tunnel Syndrome can have two sub-types, depending on where the injury occurs. These variations are called Posterior Tarsal Tunnel Syndrome and Anterior Tarsal Tunnel Syndrome.
What are the Symptoms of Tarsal Tunnel Syndrome?
Because tarsal tunnel syndrome is the compression of the nerves in the tarsal tunnel, which is comprised of the medial plantar nerves and lateral plantar nerves, the symptoms can vary slightly depending on the case. Generally, though, the nerve impingement will cause:
- Muscle weakness in the ankle or the foot
- Numbness, tingling, burning, or pain in the foot, ankle, toes, or the bottom of your foot
- Foot swelling
These symptoms are likely to increase when you stand or walk, and decrease when you rest. They are generally centered on the inside of the foot, below the ball of your ankle and down towards the arch of your foot.
Because TTS is nerve compression, the severity of the symptoms will generally depend on how compressed the nerve has become in the tarsal tunnel. Slight compressions will produce less severe symptoms than tight compressions will.
If left to its own and not treated, the nerve impingement will likely continue. In many cases, it will get worse and the posterior tibial nerve can get damaged from the impingement.
Treating Tarsal Tunnel Syndrome
The best way to treat tarsal tunnel syndrome is to catch it early, before it has gotten severe. The proper treatment, however, will depend on the circumstances, particularly on whether the TTS is being caused by another medical condition.
Common conditions that cause tarsal tunnel syndrome include flat feet alignment or fallen arches. If you exercise strenuously with these conditions, you can develop TTS. If this is the case, the proper treatment can be to focus on fixing the underlying cause, often with orthotic inserts that correct your alignment. This can fix your TTS very quickly.
If no other medical condition is causing your tarsal tunnel syndrome, most cases are treated conservatively with rest and physical therapy. This would likely include:
- Exercises that make the nerve “slide and glide” around the ankle, freeing it from the compression and opening the tarsal tunnel
- Strengthening exercises that target weak foot and ankle muscles that may have contributed to the TTS
- Mobility exercises to restore any loss of motion
- Balance exercises to restore foot coordination
Generally, physical therapy will lead to significant improvements. Many people with tarsal tunnel syndrome report feeling improvements in the symptoms right after starting therapy. Full recovery may take between 2 weeks and 6 months.
If these conservative treatments are not fixing your TTS, though, other surgical options are available.
Tarsal Tunnel Release Surgery
A tarsal tunnel release is a surgical procedure that relieves the pressure exerted on your posterior tibial nerve within the tarsal tunnel.
Exactly how it is released will depend on why it has become compressed or impinged.
After making a small incision between the medial malleolus of the ankle and bottom of your foot, the surgeon will look for any obstructions that have gotten into the tunnel and are causing the compression of the nerve. If there are any, they will be removed. If there are no obvious obstructions, the surgeon will cut along the path of the nerve on the outside of the tarsal tunnel. This will make the tissue stretch and create more space for the nerves inside the tunnel. They will also often look for additional points of nerve compression further downstream in your foot.
After closing the incision and bandaging your foot, you may be given a splint or a postoperative boot to wear and be sent home. Tarsal tunnel release surgery is an outpatient procedure that typically takes about an hour.
How Long is the Recovery from Tarsal Tunnel Surgery?
Ideally, your pain or nerve symptoms will begin to be relieved very soon after the surgery – sometimes immediately. Patients typically make a recovery in around 4 to 6 weeks if there are no complications. However, if you have had tarsal tunnel syndrome for a long time and the tibial nerve has become damaged, it may take much longer for the symptoms to subside – sometimes as long as 6 months or a year.
Depending on the circumstances, your surgeon may favor postoperative care that either aims to immobilize your foot and ankle for recovery, or aims to allow for as much mobility for the nerve as possible. The amount of scar tissue created by the surgical procedure is often a primary factor in this decision.
Generally, though, patients who have had a tarsal tunnel release surgery can walk carefully on the foot within a couple of days, use crutches for about 3 weeks, and face few limitations after 6 weeks.
Consult a Healthcare Professional for Advice Today
Getting TTS properly diagnosed is the first step towards a full recovery. The best way to make sure that you are actually suffering from tarsal tunnel syndrome is to see a qualified healthcare professional for personalized advice, a diagnosis, and treatment recommendations.
Seeing someone soon is important. Letting TTS continue untreated will only make the condition worse.
