From the Guidelines
The initial treatment plan for tarsal tunnel syndrome should focus on conservative measures, including open-backed shoes, heel lifts or orthoses, NSAIDs, decreased activity, stretching exercises, and weight loss (if indicated) 1. When managing tarsal tunnel syndrome, it is essential to prioritize measures that reduce pressure on the posterior tibial nerve.
- Conservative treatment options are recommended as the first line of treatment, aiming to alleviate pain and inflammation.
- Open-backed shoes can help reduce pressure on the area, while heel lifts or orthoses can provide additional support and correction of foot mechanics.
- NSAIDs, such as ibuprofen or naproxen, can be used to manage pain and inflammation, although their use should be limited to 1-2 weeks due to potential side effects.
- Decreased activity, stretching exercises, and weight loss (if indicated) are also crucial components of the initial treatment plan, as they can help reduce pressure on the nerve and promote healing.
- Local injections of corticosteroids are not recommended as an initial treatment option 1.
- If improvement occurs within six to eight weeks, treatments are continued until symptoms resolve, and more invasive options are considered only if conservative measures fail to provide adequate relief.
From the Research
Initial Treatment Plan for Tarsal Tunnel Syndrome
The initial treatment plan for tarsal tunnel syndrome typically involves conservative management to reduce or remove the external compression along the posterior tibial nerve. This may include:
- Activity modification to avoid exacerbating the condition 2
- Administration of pain relief drugs to manage symptoms 2
- Physical and rehabilitation medicine to improve foot and ankle function 2
- Corticosteroid injections into the tarsal tunnel to reduce swelling and relieve pressure on the nerve 2, 3
- Shoe modifications to reduce pressure on the foot and ankle 4
Non-Surgical Interventions
Non-surgical interventions are often the first line of treatment for tarsal tunnel syndrome. These may include:
- Physical therapy to improve foot and ankle mobility and strength 4, 5
- Orthotic devices or shoe inserts to reduce pressure on the foot and ankle 4
- Pain management techniques, such as medication or nerve blocks, to relieve symptoms 2, 3
Indications for Surgical Treatment
Surgical treatment is typically considered if conservative management fails to relieve symptoms. Indications for surgical treatment include:
- Failure of conservative treatment 2, 3
- Clear identification of the cause of the entrapment 2
- Abnormally slow nerve conduction through the posterior tibial nerve 2 Surgical treatment involves releasing the flexor retinaculum from its proximal attachment near the medial malleolus down to the sustentaculum tali 2. Ultrasound-guided tarsal tunnel release is also possible 2.