Heel Pain: Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome is a common heel pain typically found in active adults but can occur in children too. The tarsal tunnel is a space found near the ankle bone. Before we continue it is helpful to take a close look at the anatomy of the ankle and just how this pathology affects the heel.

Just over the tarsal tunnel space is a thick ligament, flexor reticulum, that covers and protects the other important structures within the ankle such as arteries, veins, tendons and nerve. The main nerve that sits there is called the posterior tibial nerve. Nerves protect the foot by sending your brain messages on touch and pressure. When the pressure exceeds the safety limit this is when you experience pain. When the tarsal tunnel narrows, this compresses the posterior tibial nerve, this elicits pain.

So if the nerve gets compressed why doesn't the whole foot ache? Here is when the foot gets even more fascinating. Each part of your foot is stimulated by an alternative nerve.  Looking at the diagram below it is easy to see just how much of the nerves affect the foot. The posterior tibial nerve sits in the pink section of the calcanea nerve. This is why you only experience pain in the heel. 

The common causes for tarsal tunnel syndrome are:

  • Systemic problems like forms of arthritis and diabetes.
  • Enlarged structures that can cause compression like cysts, ganglions, vericose veins and bone spurs.
  • Trauma to the heel which causes inflammation.
  • Flat feet.

Symptoms of Tarsal Tunnel Syndrome:

  • Pain that can be described as shooting pain in the heel. 
  • Numbness in the heel.
  • Tingling, burning pain localised in the heel. 
  • Worse in the night.
  • Aggravated by prolonged weight bearing (standing)
  • Inclination walking.
  • The pain can radiate into the calf.

DG Podiatrist aims to assess the ankle and will use techniques to determine the diagnosis. Once detected can advise you on the necessary steps to help eliminate the pain. Ice therapy is strongly advised in the meanwhile to help reduce inflammation in the area. Twenty minutes of elevated ice on the ankle will prove helpful. Remove the ice and leave for forty minutes prior to reapplication of ice.