Understanding and Managing Tarsal Tunnel Syndrome and Tibial Neuropathy

At Horizon Spine & Pain of Utah, we know that chronic foot and ankle pain can greatly interfere with your ability to stay active and mobile. Conditions like tarsal tunnel syndrome and tibial neuropathy can cause burning, tingling, and shooting pains that make even simple tasks difficult. Our experienced specialists are dedicated to diagnosing and treating these nerve-related conditions with targeted therapies designed to relieve pain and restore function.

Tarsal tunnel syndrome (TTS) is a nerve compression disorder that affects the posterior tibial nerve as it travels through the tarsal tunnel, a narrow space inside the ankle next to the bones and ligaments.

Tibial neuropathy refers more broadly to damage or dysfunction of the tibial nerve, which may occur anywhere along its path from the knee down into the foot. TTS is the most common form of tibial neuropathy.

When the tibial nerve is compressed or injured, it can cause pain, numbness, or weakness in the foot and ankle—symptoms that can worsen without proper treatment.

Common causes of tarsal tunnel syndrome and tibial neuropathy include:

• Flat feet or fallen arches that stretch the nerve
• Ankle sprains or trauma
• Swelling from arthritis, varicose veins, or cysts
• Diabetes-related nerve damage
• Repetitive stress or overuse (especially in runners or workers on their feet)
• Space-occupying lesions such as bone spurs or lipomas

Risk factors include:

• Obesity
• Diabetes or peripheral neuropathy
• Jobs or activities requiring prolonged standing or walking
• Previous ankle or foot injuries
• Systemic inflammatory conditions

Early identification of underlying causes is key to effective treatment.

Tarsal tunnel syndrome and tibial neuropathy can cause a variety of symptoms that may develop gradually or suddenly. Common signs include:

• Burning or tingling sensations in the ankle or sole of the foot
• Shooting or radiating pain into the arch, heel, or toes
• Numbness in the bottom of the foot
• Weakness in foot muscles or difficulty flexing toes
• Pain that worsens with prolonged standing, walking, or at night

Symptoms often worsen with activity and may mimic plantar fasciitis or other foot conditions, making expert evaluation essential.

At Horizon Spine & Pain of Utah, our comprehensive approach ensures accurate diagnosis through:

• Detailed medical history and symptom review
• Physical examination:
  • Tinel's sign (tapping over the tibial nerve elicits tingling or pain)
  • Assessment of foot alignment and range of motion
• Electrodiagnostic testing:
  • Nerve conduction studies and electromyography (EMG) to measure nerve function
• Imaging studies:
  • Ultrasound or MRI to identify structural causes like cysts, scar tissue, or inflammation

Proper diagnosis helps us tailor treatment to your specific needs.

Most cases of tarsal tunnel syndrome respond well to conservative care, especially when caught early. We offer a variety of non-invasive treatments including:

• Activity modification: Reducing aggravating movements and improving ergonomics
• Orthotics: Custom arch supports to correct flat feet and relieve nerve pressure
• Anti-inflammatory medications: NSAIDs to reduce swelling and pain
• Physical therapy: Strengthening and stretching exercises for foot and ankle support
• Bracing or splinting: To offload pressure and promote nerve healing
• Corticosteroid injections: Ultrasound-guided for precise delivery around the nerve

These strategies can significantly reduce symptoms and promote long-term healing.

If conservative treatment isn't enough, we offer advanced, minimally invasive therapies such as:

• Peripheral nerve blocks: Targeted anesthetic injections to calm irritated nerves
• Radiofrequency ablation (RFA): Uses heat to disrupt pain signals from the nerve
• Platelet-Rich Plasma (PRP) injections: A regenerative therapy to promote tissue healing

We focus on non-surgical solutions first, helping patients avoid unnecessary procedures while still achieving excellent outcomes.

Surgery may be recommended if:

• Nerve compression is severe or due to a clear anatomical cause
• Symptoms do not improve after several months of conservative care
• There is progressive nerve damage or muscle weakness

Tarsal tunnel release surgery involves decompressing the tibial nerve by releasing tight ligaments or removing structures pressing on the nerve. Our team will carefully guide you through all your options and recovery plan if surgery is needed.

At Horizon Spine & Pain of Utah, we combine experience, technology, and compassionate care to help you feel your best:

• Board-certified specialists in pain and nerve disorders
• Advanced diagnostics and ultrasound-guided therapies
• Minimally invasive, evidence-based treatment options
• Individualized care plans tailored to your lifestyle and goals
• Commitment to helping you stay active, mobile, and pain-free

We're dedicated to helping you walk comfortably again—with confidence and without pain.