Injury. A sprained or fractured ankle and other similar types of injury that cause swelling in the foot can put pressure on the tibial nerve, compressing or trapping it and bringing on tarsal tunnel syndrome.
Intrinsic Causes of Tarsal Tunnel Syndrome
Diseases. Arthritis and diabetes can cause swelling that traps or compresses the tibial nerve.
Nerve branching. A study by Havel, in Foot and Ankle 9:117 (1988), found that of 68 affected feet, 93% displayed nerve-branching either within or after the tarsal tunnel. A branched nerve, technically known as bifurcated, has a greater surface area, and, in the cramped space of the tarsal tunnel, is more likely to be trapped.
Tumors. Localised tumors or other swellings can also pressurize the whole tarsal tunnel area.
Top 10 Remedies and Treatments for Tarsal Tunnel Syndrome
1. Rest. It sounds obvious, but it needs saying: keeping weight off the affected foot will only help matters. Take it easy.
2. Elevation. Raising the foot where possible is even better at taking the pressure off, and increases blood flow.
3. Massage. Seeing a qualified masseuse could help alleviate muscular agitation in the foot and ankle.
4. Ice. An ice pack will help to reduce the swelling. Make sure you place a towel between the affected area and the pack itself, and keep the ice on for no more than twenty minutes. After removing the ice, wait for at least forty minutes before using it again.
5. Immobilisation. Restricting the foot's movement by wearing a cast can help reduce inflammation.
6. Orthotic devices. These include specially supportive shoes or, if you have flat feet, braces, reducing pressure on the foot.
There has been much recent debate over the effectiveness of 'conservative treatments' such as the methods above, which fall into the category of orthotic treatment. This simply means re-positioning the foot in an attempt to reduce trauma and swelling. However, in an article in Podiatry Today, 'Rethinking Tarsal Tunnel Syndrome,' (Vol. 7, Issue 12, December 2004) Paul R. Scherer points out that to date there have been no clinical studies of the effectiveness of orthotic treatment - it's used because of anecdotal evidence, tradition and the experience of individual doctors. That's not to say these methods don't help, but if they fail to clear up the problem, you might want to try some of the treatments below.
7. Physical therapy. Specially designed exercises, and sometimes even ultrasound therapy, are sometimes recommended. Ask your doctor.
8. Oral Medication. Anti-inflammatory drugs, such as the readily available Ibuprofen, will take down the swelling and reduce pressure on the trapped nerve.
9. Injections. Anti-inflammatory or anaesthetic injections are especially useful if the symptoms are caused by swelling in or close to the tarsal tunnel, either caused by an external injury or a separate disease (see causes).
10. Surgery. Podiatrists approach this resort with caution, as there is a high likelihood of post-operative complications, particularly the interruption of motor functions and normal feeling within the foot. However, a study by Gundring et al. (Foot and Ankle Vol. 24, Issue 3, July 2003) found that despite the relatively likely complications, 85% of patients regarded the operation as a success, as the situation was still an improvement on suffering badly with Tarsal Tunnel Syndrome.