A Step Toward Healing: Understanding Tarsal Tunnel Syndrome
Many people are familiar with carpal tunnel syndrome, a common condition affecting the wrist, but fewer have heard of its counterpart in the lower body: tarsal tunnel syndrome. According to Megan Mahon McQuarrie, MD, C.A.Q.S.M, a primary care and sports medicine physician who treats patients at Shore Physicians Group’s Ocean City office, tarsal tunnel syndrome is a condition that can cause a wide range of uncomfortable symptoms and is often difficult to diagnose.
“Tarsal tunnel syndrome is basically the carpal tunnel of the ankle,” said Dr. McQuarrie. “It involves compression of the posterior tibial nerve, which runs through a narrow space called the tarsal tunnel — a structure located along the inside of the ankle.”
This tunnel is surrounded by bones and a thick band of tissue called the flexor retinaculum (or fascia), which holds several important structures in place, including nerves, tendons, and arteries. When that band thickens due to overuse, injury, or underlying foot structure issues like flat feet, it can place pressure on the nerve and other structures within the tunnel.
What Does Tarsal Tunnel Syndrome Feel Like?
People with tarsal tunnel syndrome may experience aching, numbness, tingling, or even a “dead” feeling in the foot. Weakness is also common.
“You may feel like your foot is going numb or tingling, or you might have aching pain or weakness,” Dr. McQuarrie explained. “It’s all from compression on the nerve that goes through that tunnel. And it’s not just nerves — you can also get tendonitis, because the tendons running through the tunnel are being compressed too.”
The variety of symptoms and the complex anatomy of the ankle can make diagnosis challenging.
“There are so many tendons, muscles, nerves, and arteries going through the ankle that it can be hard to pinpoint exactly what’s causing the issue,” said Dr. McQuarrie.
People with flat feet are particularly at risk. “If you have flat feet, that puts a lot of pressure on the tunnel. It can lead to tendonitis and nerve symptoms because of the altered mechanics of the foot,” she added.
Is It a Nerve, Muscle, or Tendon Issue?
“It’s often a combination of all three,” said Dr. McQuarrie. “Muscle pain usually presents as tenderness during movement, like jumping. But when you lose sensation — like your foot going dead — that’s nerve-related. That’s why it can be a tough diagnosis; you have to systematically rule out different possibilities.”
How Is It Diagnosed and Treated?
Diagnosis begins with a physical exam and a visual assessment of foot structure. “We look at how you stand — for example, if you’re flat-footed — and then we may get imaging like X-rays to look at the bony anatomy or MRI and ultrasound to evaluate soft tissues,” Dr. McQuarrie explained.
In some cases, if there’s still uncertainty, a nerve conduction study may be performed to determine where the compression is occurring. “That test shows if the compression is at the ankle or coming from higher up, like the back,” she noted.
Dr. McQuarrie said that conservative treatment usually comes first. This may include orthotics for arch support, activity modification, or physical therapy. In some cases, injections may be used.
“There are injections we can do using lidocaine or a corticosteroid to relieve pressure and inflammation in the tunnel,” she said. “We can do this under ultrasound guidance to target the affected area.”
Patients may also be placed in a CAM boot (controlled ankle motion boot) to stabilize the ankle and reduce stress on the nerve.
Advanced treatment options can include shockwave therapy — a form of therapeutic ultrasound used to stimulate healing — or, in severe cases, surgical release of the tarsal tunnel.
Why See a Sports Medicine Specialist?
Because the symptoms of tarsal tunnel syndrome can mimic other conditions, Dr. McQuarrie emphasized the value of seeing a provider trained in both primary care and sports medicine.
“With the sports medicine training, I’ve had additional education in anatomy, gait analysis, and the use of musculoskeletal ultrasound, which helps with both diagnosis and treatment,” she said. “Whether you’re a competitive athlete or a weekend warrior, we’re trained to evaluate your movement and identify weaknesses or imbalances that may be contributing to your pain.”
According to the American College of Foot and Ankle Surgeons, tarsal tunnel syndrome is a condition that should not be ignored. Without treatment, symptoms can worsen and lead to permanent nerve damage. Source: FootHealthFacts.org
Dr. McQuarrie treats patients ages 10 and older at Shore Physicians Group’s Ocean City office, located at 1645 Haven Avenue, Suite C, Ocean City, NJ. Appointments can be made by calling 609-399-6263.
