From the Research
Treatment for tarsal tunnel syndrome should begin with conservative approaches, including rest, ice application, and activity modification, before considering surgical intervention, as indicated by the most recent and highest quality study 1. The initial treatment includes rest, ice application, and activity modification to reduce pressure on the posterior tibial nerve.
- Over-the-counter NSAIDs like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) can help manage pain and inflammation, as suggested by 2 and 3.
- Custom orthotic inserts or supportive shoes with good arch support are essential to correct foot mechanics and reduce nerve compression.
- Physical therapy focusing on stretching exercises for the calf muscles and foot intrinsics can improve flexibility and reduce symptoms.
- For more significant pain, a healthcare provider may recommend corticosteroid injections (such as methylprednisolone 40mg mixed with lidocaine) into the tarsal tunnel to reduce inflammation, as mentioned in 4 and 5.
- Night splints may help maintain the foot in a neutral position during sleep. If conservative measures fail after 6-12 weeks, surgical decompression of the tarsal tunnel may be necessary to release the compressed nerve, with excellent or good results seen in 75.3% of cases, according to 1. This procedure involves cutting the flexor retinaculum to create more space for the nerve.
- Recovery from surgery typically takes 6-12 weeks, with gradual return to normal activities.
- Tarsal tunnel syndrome treatment works by reducing pressure on the posterior tibial nerve, decreasing inflammation, and correcting biomechanical issues that contribute to nerve compression, as explained in 2 and 3. The management of tarsal tunnel syndrome should be individualized, taking into account factors such as patient age, symptom duration, aetiology, co-morbidities, pre-treatment symptom severity, and nerve fibrosis, as identified in 1.