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Tarsal Tunnel; “The Other Tunnel Syndrome”

Most people are familiar with carpal tunnel syndrome involving the hand which is caused by overuse and/or anatomical factors, resulting in pain, numbness/tingling, and limited function of the hand. However, there is another “tunnel syndrome” involving the foot called Tarsal Tunnel Syndrome that results in similar symptoms, and is often not detected or is misdiagnosed as plantar fasciitis, heel spur syndrome, or achilles tendonitis. Diagnosis is difficult because the location of pain for all of these conditions is very similar with pain being felt over the inferior heel and arch. However, the behavior or nature of the pain is somewhat different.


Tarsal tunnel syndrome is caused by an inflammation of the tibial nerve that travels just behind the inside ankle bone traveling on to the arch of the foot and toes. The nerve can become irritated because of traction or stretching along its course of travel, or due to compression in one of the two main tunnels in which it travels. The first tunnel is located just behind the ankle, and the second tunnel is located along the inside part of the heel. This is the reason its symptoms or location of pain can be very similar to plantar fasciitis or heel spur syndrome.


According to Bucky Whiteman, physical therapist at Progressive Physical Therapy and Sports Medicine Clinic, the diagnosis of Tarsal Tunnel Syndrome can be somewhat complicated to make. Although, some complaints with tarsal tunnel syndrome and plantar fasciitis are similar, there are specific symptoms that separate the two. People with plantar fasciitis typically experience more pain in the morning upon waking that decreases with weight bearing and activity. Pain is seldom present at rest or at night with plantar fasciitis, but will increase upon standing after periods of sitting.


Tarsal tunnel symptoms may be worse in the morning upon waking, but typically increase throughout the day, are typically present at rest and sometimes are present at night and interfere with sleep. In addition, people with Tarsal Tunnel Syndrome typically complain of “burning and/or stinging”, “tingling” and numbness over the inferior heel and arch region not usually associated with plantar fasciitis or heel spur syndrome. Furthermore, the area of tenderness to touch differs between tarsal tunnel syndrome and plantar fasciitis. People with Tarsal Tunnel Syndrome are most tender on the inside of the heel just below the ankle, and tapping in this area may reproduce the symptoms of stinging and tingling. The area of tenderness with plantar fasciitis is on the bottom of the heel and arch.


The key to treating both conditions is an accurate diagnosis and determining the cause of the inflammation that has resulted in pain. Factors include improper shoes, improper training habits, weakness, inflexibility, trauma, excessive weight, and biomechanical factors such as being flat footed or having too high of an arch. Treatment is aimed at addressing these factors and can include shoeware changes, changes in training techniques, strengthening and flexibility exercises, weight reduction, and orthotics, which are basically custom shoe insoles used to correct biomechanical factors. More aggressive treatment includes anti-inflammatory drugs, ultrasound, iontophoresis, or possible cortisone injection to the involved area. Ultimately, if these measures are unsuccessful in alleviating symptoms surgery is sometimes necessary to eliminate compression of the nerve occurring due to scarring within the tarsal tunnel.


If you are experiencing heel pain consult your physician, podiatrist, or physical therapist so that an accurate diagnosis may be made early. The earlier that appropriate treatment is initiated, the less likely your problem is the become chronic and the quicker you will return to the activities you enjoy.


Submitted by: Bucky Whiteman, MBA, PTProgressive Physical Therapy and Sports Medicine Clinic

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