From the Research
Treatment for tarsal tunnel syndrome should begin with conservative measures, including rest, ice application, and activity modification, before considering surgical options, as recommended by the most recent and highest quality study 1. The initial treatment approach for tarsal tunnel syndrome typically involves a combination of non-pharmacological and pharmacological interventions. Some key considerations include:
- Rest, ice application, and activity modification to reduce pressure on the posterior tibial nerve
- Over-the-counter anti-inflammatory medications like ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) to help reduce inflammation and pain
- Custom orthotic inserts or supportive shoes with good arch support to correct foot positioning and reduce nerve compression
- Physical therapy exercises focusing on stretching the calf muscles and strengthening the foot muscles, performed daily for 15-20 minutes For more severe pain, a physician may prescribe corticosteroid injections into the tarsal tunnel to reduce inflammation, though these are typically limited to 2-3 injections per year 2. Night splints may be used to keep the foot in a neutral position during sleep. If conservative treatments fail after 4-6 weeks, surgical decompression of the tarsal tunnel may be necessary to release pressure on the nerve, with surgical success rates varying from 44% to 96% 2. Recovery from surgery typically takes 6-12 weeks. The effectiveness of these treatments varies because tarsal tunnel syndrome results from compression of the posterior tibial nerve as it passes through the narrow space behind the inner ankle bone, and addressing the specific cause of compression is essential for successful treatment 3, 4, 5.