Tarsal Tunnel Syndrome: Pain In Your Foot
Jun 5th, 2009 by Kathryn Merrow
Tarsal Tunnel Syndrome (TTS) is much the same as Carpal Tunnel Syndrome…except the Tarsal Tunnel is in your ankle.
Here’s a recent email I received from Tom:
“I came across your group on Facebook, about Carpal Tunnel Syndrome Relief. I have the leg version of this complaint, Tarsal Tunnel Syndrome and am about to have an operation to rectify it. Do you have any information on Tarsal Tunnel? I ask because I’ve not managed to find much about it other than the operation doesn’t have a very high success rate. I’m clinging to the hope that my op DOES work.”
Here’s my response to Tom:
“My best resource is ‘Myofascial Pain and Dysfunction, The Trigger Point Manual, Vol. 2, The Lower Extremeties‘ by Travell & Simons, MD’s. These 2 volumes may be (and should be) on your surgeon’s or physician’s bookshelf. Here is my translation of what they have to say about TTS in a nutshell.
Regarding surgery:
The doctors said that surgery to release the tibial nerve and the medial and lateral plantar nerves as they passed through and deep to (behind; more inside) the abductor hallucis muscle was successful in 9 of 10 TTS release surgeries. That means 90% were successful. Sometimes, part of the abductor hallucis is removed.
The doctors said: “The possible (likely) role of myofascial TrPs in the abductor hallucis was apparently not considered in these patients with heel pain.” What does that mean? The doctors Travell & Simons were aware that muscles and soft tissues (not bony tissue) cause a huge amount of our pain and other symptoms. It means that if Travell or Simons were your doctor, they would be looking for trigger points as the cause of your pain before they considered surgery. (TrPs = trigger points.)
What causes tarsal tunnel syndrome?
Running, jumping and shoes that are too tight–not wide enough–can be a cause. Also, in 2 cases, the abductor hallucis muscle was 3 times larger than normal, and in one case, had an additional muscle belly. In those 3 cases, the extra-large muscle pressed on the nerves.
What are trigger points?
If you go to Carpal Tunnel Pain Relief, and scroll down to ‘Categories’ and scroll to “Triggers and Triggers Points” you will find articles describing trigger points and their causes. Basically, they are extremely irritable spots in soft tissue or muscle that “fire” or cause pain elsewhere, sometimes at a very far distance from the trigger point.
Like everything else, trigger points are caused by something. The ’something’ has to be corrected (I’m thinking posture here rather than surgery,) released, or relaxed, as well as the trigger point. Trigger points can be released with manual (hand) pressure by a massage or muscular therapist.
Where is the abductor hallucis muscle?
Basically the muscle is in the arch of your foot, on the side that is closest to your other foot.
What causes the TTS symptoms?
A ’syndrome’ is a collection of symptoms. Symptoms are your pain, numbness, tingling, headache, etc. Everything has a cause: Symptoms are caused by ’something.’
When the abductor hallucis muscle becomes taut it presses, or entraps, the nerves that pass deep to it. ‘Taut’ is not the same as ‘tight.’ Taut = a rope being pulled on from both ends. When a muscle is taut, it is being pulled on from both of its’ ends. The rope, or muscle, cannot relax because it is being pulled too tightly.
‘The Rehabilitation Specialist’s Handbook‘ says TTS is a compression of the nerves in the ankle, and it does mention some reasons that could cause compression in the area. It does not, however, suggest that muscles might be the cause of the symptoms.
Actually, little is understood by the medical field about trigger points and the roles of muscles in soft tissue pain because that’s not something most doctors learned in medical school. (Nor did we in school.) And while muscles are the usual cause of symptoms, of course, sometimes there are other causes like a bone or blood vessel deformity or a crushing injury.
So where would the cause actually be?
In the muscles on the top of your foot as well as the abductor hallucis. Muscles act like a labor union: If one goes out on strike, others follow. Rarely do muscles act alone. All of the surrounding area, foot and leg, will be likely taking part in the action. That means that all of the muscles should be massaged or manually treated.
Who would do the treatment?
I’d recommend a neuromuscular massage therapist, especially one trained in the Paul St. John Method of NMT. They seek to eliminate causes of pain, rather than just treat the symptom.
There are probably some doctors who would use Travell & Simons’ method of ’spray & stretch’ to release the muscle and restore normal movement to the ankle and toes. A doctor will spray a vapocoolant on the tight areas which anesthesizes them and then stretch the muscles and joints.
Travell (deceased) & Simons are Medical Doctors, not massage therapists, so they did ‘doctorly’ stuff rather than too much soft tissue massage. Regardless, trigger points can be released both ways.
A stretch that is mentioned in the “Trigger Point Manuals” involves extending the great toe, and massaging the muscles in the arch deeply and slowly toward the great toe to stretch and release them.
My personal, first choice for a treatment would always be the least invasive. That means I’d rather see whether manual therapies would help before I’d try surgery.”
And, I wished Tom a good resolution of his Tarsal Tunnel Syndrome.
i have been tossed around from doctor to doctor for 2 years now because they can’t decide if it’s my back thats causing my foot to be numb, weak, and crampy or if it really began in my foot. I was first diagnosed with L5 radiculopathy but when things were getting worse i went to different doctors. So now 2 years later i find out that i have tarsal tunnel syndrom from an old injury in my foot. The pain in sevear and causes my whole back to cramp up because of the way i walk with no feeling in half my foot. Everything i read tells me that its a tissue build up compressing the nerves and if treated early can be fixed through physical therapy/medicain. is it to late to be physically rehabilitated?
Hi Stephanie,
By now you have hopefully received my response by email. I’m glad you finally got a diagnosis. I suggested in the email several things you can do to start the process of healing. It’s really too bad that most of the medical profession doesn’t pay much attention to the roles of muscles in pain syndromes. That’s not something that gets taught much in medical school. That’s why there are muscle specialists. One of the things I suggested beside massage and ice is to buy a copy of the blue trigger point book that is for sale on the right hand side of this site. The muscles that are responsible for causing TTS symptoms are shown and release treatment is demonstrated. The book is for do-it-yourself pain relief. You have a smart body that wants to be well. Right now, it just needs a little help from you. By educating yourself, you have the best chance of getting better, no matter which route you take. Since numbness is involved, and nerves heal very, very slowly, it may take quite a while until you get all of your sensation back. In the meantime, you might start a whole body movement program just to help the rest of your muscles get back into balance, too. I wish you the best and please feel free to contact me again.
Kathryn Merrow
The Pain Relief Coach
i was wondering if i have tarsal tunnel syndrome or if its something else. Normally my feet don’t hurt, but when i excercise (especially jumping excercises) i get severe pain at the bottom of my foot (in the arch area). The pain is often really bad and this is preventing me from doing a lot of the exercises that i like. I also know that the pain is not caused by bad shoes, because it happens with all shoes, even running shoes. Does this sound like tarsal tunnel syndrome?
Hi Alicia, A “syndrome” is a bunch of symptoms. It’s possible that in your case you may need orthotics (arch supports) to support your arch while you jump/exercise.
It’s also possible that tight calf muscles are causing this pain in your arch. It may or may not be tarsal tunnel syndrome but here are some suggestions: Deeply massage the arch of each foot, looking for tender areas and applying pressure to them. Search the whole arch area and press into the areas where the bones and muscles meet (ball of foot and heel.)
You can “massage” your calf by rolling it on a tennis ball as you apply pressure, or on your opposite knee. If you find tender areas that generally means tight muscles that need pressure or massage to “release” or relax them.
You can also take the time when your muscles are warmed up but before you begin your exercise to stretch your calves. Please look for a new article on this question in a few days. Thank you for writing!
I have been to several doctors with my heel pain. Two of them diagnosed me with a heel spur and set up surgery in January. But yesterday I went to another doctor who told me I did not have heel spurs, but tarsel tunnel, which I had never heard of. He is sending me to a neurologist in Jan to have a nerve test on my leg and foot. In 1987 I had an accident in which my leg was severly hurt. The new doc said this could be the root of pain in my heel. Does tarsel tunnel feel like sharp pains in your heal?
I have had a cortisone shot but felt no relief. What would you recommend?
Hi Tommy,
Tarsal tunnel symptoms can be felt as pain, burning or tingling on the sole (bottom) of the foot. You may also feel it on the side of the ankle (the side where your arch is.) Symptoms are usually worse as the day goes on and can usually be relieved by elevating your foot, rest or massage. We are not talking sweet gentle massage here–You want deep pressure into the muscles in the arch of your foot to really get into the muscle.
Injury can cause TTS, possibly because of scar tissue that develops. Flat feet can also develop TTS because walking flat-footed puts a strain on the muscles of the arch. The muscle in the arch of your foot can press on the nerve that causes the TTS symptoms.
I am not a doctor but my first recommendation is always the one that causes the least trauma or change to a body. That would be deep tissue massage and trigger point massage, in your case. (And in most cases.)
Probably 90% of our pain is caused by muscles so that is generally my first plan of attack. On the other hand, sometimes surgery is required, for example, to remove a bone chip. On the other hand, sometimes it LOOKS like a bone chip or other situation when tests are examined but treating the muscles with massage or a cortisone shot relieve the pain of the “bone chip.”
If you have normal strength and movement in your body, hands & arms, you may be able to get deeply into your arch muscles. If you cannot apply enough pressure yourself (if you can’t “hurt” yourself enough) then interview professional massage therapists to find one who is familiar with TTS and can treat it. Go into the “Massage” Category here to learn how to find a massage therapist who can actually help you. You may want to postpone your surgery for a month to give yourself the chance to have your symptoms treated by a massage therapist. You should know within a couple of sessions. Once more I will tell you: Manual pressure into tight muscles will not be comfortable but may make a world of difference!
If you have flat feet, custom orthotics or firm arch supports may give relief and can be used with massage. I hope this gives you some help.
Best,
Kathryn Merrow
The Pain Relief Coach
I have been diagnosed with Tarsal Tunnell Sydrome, I am having an operation to fix it. Can anyone give me some information on what it involves and what is the recovary period please?
Hi Janice, Here is the link to an article that will give you more information about tarsal tunnel syndrome. http://www.podiatrytoday.com/article/3337 Whenever you are cut, your tissues are damaged. It’s an injury like any other injury.
Part of your success will depend on the ability and skill of your surgeon. Part of your successful recovery will depend if the surgeon actually is correct in his diagnosis. Ask lots of questions so you get answers that make you comfortable with your decision.
The surgeon should be able to tell you whether he expects you to have 100% recovery and how long it will take to get there. Seems like most surgeries take up to six weeks to recover. You are paying the surgeon (even if it’s insurance paying) so it’s perfectly fine for you to ask questions.
There may be more helpful information for you in the rest of the comments under this article. In the end, remember it’s your body and you get to make the decisions.
I wish you the best.
Kathryn