Not all heel pain is from plantar fasciitis. Heel pain can be caused by a variety of conditions, one of which is Tarsal Tunnel Syndrome. This condition is similar to carpal tunnel syndrome in the wrist, but it occurs in the ankle. It is a result of compression of the posterior tibial nerve, which runs through the tarsal tunnel on the (medial) inside of the ankle. This compression can lead to pain, tingling, and numbness in the heel and foot. Typically folks have pain toward the end of the day with tarsal tunnel syndrome rather than pain when getting up from a seated position like with plantar fasciitis.
Causes of Tarsal Tunnel Syndrome
There are several factors that can contribute to the development of Tarsal Tunnel Syndrome. Most of the factors include some sort of swelling and pressure around the nerve.
Factors Contributing to Tarsal Tunnel Syndrome:
Obesity: Being overweight can put extra pressure on the foot and ankle, which can lead to nerve compression.
Trauma: Injuries such as sprains or fractures can cause swelling in the ankle.
Arthritis: Inflammation and swelling in the ankle joint from arthritis can also cause entrapment of the nerve.
Flatfoot: This condition can cause the arch of the foot to collapse and pronate causing excessive stress on the nerve.
Varicose Veins: Arteries and veins run with the nerves. Varicose veins filled with blood put pressure on the nerve.
Overuse: Repetitive motions such as running or walking with the foot and ankle in pronated position can put stress on the foot and ankle, which can lead to nerve compression over time.
Symptoms of Tarsal Tunnel Syndrome
The symptoms of Tarsal Tunnel Syndrome can vary from person to person, but they typically include:
Heel pain: This pain is usually described as a burning or aching sensation and can be severe.
Tingling or numbness: This sensation is usually felt in the heel and foot and can be accompanied by a pins-and-needles feeling.
Weakness: Some people may experience weakness in the foot or ankle, which can make it difficult to walk or stand.
Cramping: Some people may experience cramping in the foot or ankle.
Pain that gradually increases after standing for long periods and is worse at the end of the day.
Treatment of Tarsal Tunnel Syndrome
The treatment of Tarsal Tunnel Syndrome will depend on the underlying cause of the condition. Some options include:
Rest and ice: Resting the foot and ankle and applying ice can help to reduce inflammation and pain.
Physical therapy: Physical therapy can help to strengthen the muscles in the foot and ankle, which can help to reduce nerve compression. Neural glide techniques help to allow the nerve to move freely.
Medications: Over-the-counter pain relievers such as ibuprofen can help to reduce pain and inflammation. Topical pain relievers like voltaren gel can also be helpful.
Orthotics: Shoe inserts or orthotics can help to support the arch of the foot, which can help to reduce nerve compression after the inflammation has resolved. Inserts can actually cause increased pressure on the nerve.
Laser therapy: 4-6 treatments with laser therapy can reduce inflammation around the nerve.
Peripheral nerve injection: A therapeutic and diagnostic injection of lidocaine with a little bit of steroid can decrease inflammation and allow the nerve to glide in the tarsal tunnel.
Surgery: As a last result surgery may be required to release the compressed nerve.
If you are experiencing heel pain, it is important to see a doctor to determine the cause. Tarsal Tunnel Syndrome is just one of many conditions that can cause heel pain, and treatment will depend on the underlying cause. With proper diagnosis and treatment, it is possible to relieve pain and improve function. If you have tried stretching, inserts, new shoes and ibuprofen without relief from your heel pain we can help. Give us a call to schedule an appointment so we can get you back to doing the things you love.
