Tarsal tunnel syndrome in runners: diagnosis and return to physical activity - a review

Aim: Tarsal Tunnel Syndrome (TTS) is a rare compressive neuropathy of the posterior tibial nerve, often undiagnosed but particularly relevant to runners due to the unique biomechanical demands of the sport. Running places repetitive stress on the foot and ankle, increasing susceptibility to nerve compression within the tarsal tunnel.

Materials and Methods: This review examines the anatomical structure of the tarsal tunnel, the etiology, and epidemiology of TTS, and highlights risk factors such as excessive pronation, high arches, and prior ankle injuries. Diagnosis relies on clinical assessments like the Tinel test, imaging techniques, and neurophysiological tests. Treatment ranges from conservative approaches, including orthoses, physical therapy, and nonsteroidal anti-inflammatory drugs (NSAIDs), to surgical interventions for nerve decompression, with emerging minimally invasive techniques gaining popularity. Rehabilitation is critical for restoring functionality and enabling runners to return to physical activity.

Conclusions: Comprehensive management of TTS, particularly for runners, involves a holistic approach encompassing prevention strategies, proper diagnosis, and individualized rehabilitation protocols. This review underscores the importance of increasing awareness of TTS among healthcare professionals and athletes to improve early detection, optimize treatment outcomes, and prevent recurrence.