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Tarsal tunnel syndrome (“TTS”) in the foot is somewhat like carpal tunnel syndrome in the hand. Both conditions are due to compression of a nerve. In the case of carpal tunnel syndrome, it's the median nerve as it crosses the wrist, and in TTS it's the posterior tibial nerve as it crosses behind the inside (medial) of the ankle.
Just like in carpal tunnel syndrome, symptoms of TTS include pain, numbness, and tingling in the foot, heel, sole, and sometimes into the medial aspect of the ankle and even up into the lower part of the calf. The pain is often “burning,” but it can be sharp, sudden and severe.
Walking and standing aggravate the pain. Resting helps, but in some patients there is considerable pain while sitting and at night.
What Causes Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome can be caused by any condition that compresses the tibial nerve as it passes through a bony canal at the ankle called the “tarsal tunnel.” Any space occupying lesion, such as cysts (e.g. ganglion cysts), lipomas (fatty tumors), or schwannomas (tumors of the nerve sheath) can cause TTS.
Trauma, injury, inflammation, arthritis, diabetes mellitus, and other conditions can predispose a person to develop tarsal tunnel syndrome. Patients with “flat feet” are predisposed to TTS because “fallen” arches stretch the tibial nerve.
Other conditions must be differentiated from TTS. They include plantar fasciitis, tendinitis, neuropathy, stress fractures, and reflex sympathetic dystrophy (RSD).
A diagnosis of tarsal tunnel syndrome may be suggested if on physical examination pressure causes localized tenderness in the area of the tibial nerve as it passes along the ankle and into the foot. (This is like Tinel's test at the wrist for carpal tunnel syndrome.)
X-rays, imaging (MRI) studies, and electromyography (EMG), with nerve conduction testing help to confirm the diagnosis.
Treatment depends on the symptoms. Mild cases of TTS often respond to decreased weight bearing, non-rigid orthotics, physical therapy, non-steroidal anti-inflammatory medications, and local corticosteroid injections.
However, surgery may be required to decompress the tibial nerve, if conservative measures do not work.
Disability Benefits for Tarsal Tunnel Syndrome
Entitlement to long-term disability (LTD) benefits under the Social Security Administration (SSDI) and/or a private group disability plan (ERISA) for TTS depends on the severity of the condition. Some patients with TTS are unable to stand or walk and can have considerable pain even at rest.
A full range of “sedentary” work requires the ability to stand/walk for at least 2 hours in an 8-hour workday. If your symptoms of pain, numbness and tingling impair your ability to stand/walk, you may qualify for an LTD award.
Your orthopedic surgeon or podiatrist should carefully document not only your diagnosis of TTS and the symptoms you have, but also your exertional physical capability related to standing and walking.
At Law Med, we handle SSDI and ERISA claims for tarsal tunnel syndrome and many other conditions.
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