Tarsal Tunnel Syndrome - A Comprehensive Review

Tarsal tunnel syndrome (TTS) refers to compression of the posterior tibial nerve as it traverses the tarsal tunnel in the ankle. First described by Keck and Lam in 1962, TTS is an underdiagnosed cause of heel pain and foot dysfunction.^1,2 The tarsal tunnel contains the tibial nerve, posterior tibial artery, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles. Compression of the tibial nerve within this tunnel leads to pain, numbness, tingling, and weakness along its distribution. The clinical presentation of TTS can vary due to the numerous etiologies and range of structures involved. Symptoms may develop insidiously over months to years or have a traumatic onset. Lack of definitive clinical tests or imaging often delays diagnosis, which contributes to poor patient outcomes and treatment success. In severe or long-standing cases, permanent nerve damage may occur if left untreated. TTS deserves increased recognition given its potential to significantly impact mobility and quality of life. This review provides a comprehensive overview of the anatomy, etiology, diagnosis, and management of TTS. Optimal strategies to diagnose and treat this condition based on available evidence are discussed to improve patient outcomes and limit disability. Early diagnosis and intervention are key to avoiding permanent nerve injury and maximizing the benefits of treatment, whether conservative or surgical.