Tarsal Tunnel Syndrome & Physiotherapy: Healing Through Movement and Bone Therapy By CKS – MedVana Physiotherapy & Wellness Blog

Introduction

Are you experiencing a burning, tingling, or shooting pain in the inside of your ankle or sole of the foot? Does your foot feel numb or "asleep" even when you haven’t moved? You could be dealing with Tarsal Tunnel Syndrome (TTS)— a lesser-known but impactful nerve compression condition.

What Is Tarsal Tunnel Syndrome?

Tarsal Tunnel Syndrome is caused by compression of the posterior tibial nerve as it passes through the tarsal tunnel, a narrow passage on the inside of your ankle. This tunnel is bounded by bones on one side and a thick ligament (flexor retinaculum) on the other.

Common Causes:

• Flat feet or overpronation

• Trauma or ankle sprain

• Varicose veins, cysts, or swelling in the tunnel

• Diabetes or systemic inflammation

• Prolonged standing or repetitive foot motion

Symptoms You Shouldn’t Ignore

• Burning, tingling, or shooting pain in the inner ankle or foot

• Numbness or weakness in the foot

• Pain that worsens with walking or prolonged standing

• Night-time symptoms or rest pain in chronic cases

How Physiotherapy Helps in Tarsal Tunnel Syndrome

Physiotherapy is a first-line, non-surgical treatment that can relieve symptoms, correct the root cause, and prevent long-term nerve damage.

We approach TTS in two complementary ways:

1. Movement Therapy: Free the Nerve, Train the Body

Nerve Gliding Techniques (Neurodynamics)

• Helps mobilize the posterior tibial nerve gently

• Reduces adhesions and improves nerve flexibility

• Enhances blood flow and reduces inflammation

Foot & Ankle Mobility Drills

• Ankle circles and inversion-eversion control

• Toe yoga and arch activation

• Towel scrunches to stimulate intrinsic muscles

Strengthening the Kinetic Chain

• Posterior tibialis and peroneal strengthening

• Glute activation (especially glute medius)

• Core control to support lower limb mechanics

Gait & Posture Re-Education

• Focus on reducing overpronation

• Training for midfoot loading and arch preservation

• Retraining foot strike in runners or walkers

2. Bone Therapy Approach: Restore Alignment & Support

Joint Mobilization

• Mobilize subtalar, talocrural, and midfoot joints

• Improve joint congruency and reduce tunnel pressure

• Relieve restrictions that exacerbate nerve entrapment

Biomechanics Correction

• Assess and correct flat foot or fallen arches

• Use of custom orthotics or arch supports

• Modify footwear for shock absorption and proper heel support

Load Management

• Activity modification to reduce repetitive strain

• Structured rest-exercise-recovery cycles

• Advice on terrain (e.g., avoiding uneven surfaces)

3. Pain & Symptom Relief Modalities (as needed)

   Ice application to reduce swelling

TENS therapy for nerve pain

Ultrasound therapy to reduce inflammation

Taping techniques to unload the tarsal tunnel

What Recovery Looks Like

With consistent physiotherapy, patients typically experience:

• Reduction in pain and numbness within weeks

• Improvement in mobility and balance

• Greater awareness of posture and foot mechanics

• Prevention of surgery or invasive interventions

Final Thoughts

Tarsal Tunnel Syndrome can be frustrating, but it's not permanent. Early physiotherapy can unlock your healing potential. Through a balance of bone alignment, nerve mobility, and functional movement, you can regain pain-free movement and foot confidence.