Foot / Ankle
Tarsal Tunnel Syndrome
족근관 증후군
Compression of the posterior tibial nerve within the tarsal tunnel behind the medial malleolus
- How common
- Uncommon — one cause of chronic plantar pain
- Typical age
- Adults of any age
What is it?
Posterior tibial nerve within the tarsal tunnel (beneath flexor retinaculum) is compressed by space-occupying lesions, flatfoot, varicosities, or trauma.
Commonly affected: Tarsal tunnel posterior-inferior to medial malleolus
How it develops
- Normal Tarsal TunnelTibial nerve passes freely below flexor retinaculum
- Space ReductionCysts, varicosities, or flatfoot reduce space
- Nerve CompressionTibial nerve compressed, develops ischemia
- Sensory/Motor DysfunctionPlantar tingling; severe cases develop weakness
Symptoms
- Plantar Burning/TinglingBurning, tingling of sole and toes
- Standing/Walking WorsensProlonged standing or walking aggravates
- Night PainNocturnal pain relieved by foot rubbing
- Radiating SensationTingling radiates distally on tapping
How it is examined
- Tinel SignTapping behind medial malleolus elicits tingling to sole
- DF-Eversion TestSustained DF + eversion reproduces symptoms
- Pes Planus AssessmentEvaluate for concurrent flatfoot
- Sensory TestingHypoesthesia in tibial nerve distribution
Imaging
X-ray rules out bony causes.
- Rules out spurs/trauma
- Often normal
MRI identifies space-occupying lesions in the tunnel.
- Ganglia, varicosities, lipomas
- Perineural edema
- Nerve enlargement
Non-surgical care
- Arch Support InsolesMedial arch support reduces nerve strain in flatfoot
- NSAIDs + Activity ModShort-term NSAIDs with activity reduction
- Nerve GlidingTibial nerve gliding exercises
- US-guided Steroid InjectionUS-guided injection decompresses the tunnel
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Failed 6-month conservative, confirmed space-occupying lesion, or motor deficit
Procedures that may be discussed
- Tarsal tunnel release
- Excision of space-occupying lesion
Outlook
70–90% improve when underlying cause is treated.