Walking on eggshells

What is tarsal tunnel syndrome?

The tarsal tunnel is a small canal, lined with bone, that lies underneath the bumps on your inner ankles. These inconspicuous tunnels are much more important than they appear -- many of the important nerves that provide sensation and control to the ankles, feet and toes are routed through these canals, and any damage to these canals can easily damage these delicate nerves. 

Tarsal tunnel syndrome, commonly abbreviated to TTS, occurs when the tarsal tunnels narrow, compressing and impinging the nerves within. This compression generally results in feelings of pain, tenderness and tingling in the affected foot. Sufferers may also notice visible swelling of the foot and ankle, and may experience transient sensations of heat and cold. The area of the foot that is affected by these symptoms depends on where in the tarsal tunnel the impingement occurs -- an impingement low in the tunnel, towards the foot, may limit symptoms to the toes and instep, while a higher impingement can affect the whole foot and even the ankle.

How can TTS be treated?

Tarsal tunnel syndrome does not enjoy the fame of its carpal cousin, which affects the hands. However, TTS can be just as painful and debilitating to its sufferers. Indeed, the pain can be so severe that many patients opt to have their TTS surgically corrected, which naturally entails all the potential risks and side effects associated with localised surgery. Fortunately, unless your case of TTS is particularly advanced and/or severe, there are a number of ways in which you can treat the symptoms of tarsal tunnel syndrome without putting yourself under the knife. 

• Rest - Many TTS sufferers will notice that pain becomes worse during exercise, particularly high-impact exercises such as jogging or field sports. A prolonged period of rest will decrease pain and give damage and inflammation in the foot a chance to heal. Allowing muscles in the feet and ankles to relax may also reduce the pressure placed on your impinged tarsal tunnel.
• Ice - Ice packs and cold packs can help to combat inflammation and numb surface pain.
• Pain relief - Pain killing medications are often prescribed to TTS sufferers by their podiatrist, and they can be effective at relieving pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often prescribed, as they also assist in reducing inflammation. Topical pain-relieving gels and patches may also be recommended. In severe cases, your podiatrist may offer an intravenous injection of analgesics directly into the affected area.
• Corticosteroids - Corticosteroid treatments are generally injected into the affected foot, and reduce pain and inflammation very quickly. However, they are not a long-term solution, and various unpleasant side effects are associated with their overuse.
• Physiotherapy - Physiotherapy may be recommended as a way to strengthen the muscles around the feet, ankles and calves, which can help take pressure off the tarsal tunnel. Physiotherapists can also help you through nerve mobilisation and realignment exercises, aimed at widening the affected tarsal tunnel and increasing flexibility in the connective tissues surrounding it.
• Orthotics and braces - In some cases of TTS, the narrowing of the tarsal tunnel is provoked or exacerbated by an irregular gait. Orthotic shoe inserts, braces and splints can all be provided to you by your podiatrist, and can help you achieve a more natural and less damaging gait. If you need to retain your mobility, night splints can be worn while to sleep to reduce symptoms during your waking hours.