Tarsal tunnel syndrome is a peripheral nerve condition caused by compression of the posterior tibial nerve and its branches (The medial plantar, lateral plantar, and calcaneal nerves) as they pass through the tarsal tunnel, a narrow space on the inner side of the ankle. Sometimes we refer to this as tarsal tunnels syndrome, because there are multiple distinct tunnels.Understanding Your Next Steps
This quiz reflects patterns that Dr. Williams commonly sees in his practice. It is a starting point, not a diagnosis. Every patient's situation is different. Many factors influence whether surgery is the right path.
If your results suggest a consultation may be beneficial, the first step is completing an initial patient summary form. This form captures the specifics of your symptoms, your treatment history, and your relevant medical records. Be as thorough as possible. Noting exactly where your pain is located, when it started, what makes it better or worse, and which treatments you have already tried gives Dr. Williams the clearest possible picture before your appointment.
If a consultation is appropriate, you will come in for a hands-on examination. Dr. Williams will assess for a Tinel's sign at the tarsal tunnel (Tinel's sign test) – the space just behind and below the inner ankle bone (you may also watch the video and try this yourself) – and evaluate whether your symptoms match the sensory territory of the posterior tibial nerve and its branches. He will also assess your balance, gait, and any muscle changes in the foot.
Imaging such as ultrasound, MRI, or MR neurography may also be recommended to visualize the nerve and identify any structural issues along its path. EMG and NCVS may also be helpful in some cases.
If surgery is recommended, Dr. Williams performs a thorough release of each tunnel over each nerve (tarsal tunnel, medial plantar tunnel, lateral plantar tunnel, and calcaneal tunnels) in order to address not only the main posterior tibial nerve but all four of its distal branches: the medial plantar, lateral plantar, medial calcaneal, and inferior calcaneal nerves. In his experience, tarsal tunnel syndrome involves multiple compression points, not just one. By addressing every branch, he aims to improve the likelihood of a meaningful and lasting outcome.
