Tarsal tunnel release

Preparation

Every case requires careful evaluation and individual assessment before surgical treatment is considered.

The qualification process may include:

• orthopaedic consultation or specialist musculoskeletal evaluation,
• clinical examination,
• imaging studies,
• nerve conduction testing, such as EMG,
• assessment of foot and ankle biomechanics,
• review of previous conservative treatments.

Tarsal tunnel release may be considered in patients with tibial nerve compression within the tarsal tunnel causing chronic pain, sensory disturbances, or impaired foot function.

The procedure may be indicated in cases of:

• chronic pain along the inner ankle or sole of the foot,
• numbness, tingling, or burning sensations in the foot,
• symptoms radiating into the toes,
• worsening symptoms during walking, physical activity, or prolonged standing,
• sensory disturbances affecting the foot,
• impaired tibial nerve function,
• persistent symptoms despite rehabilitation and conservative treatment,
• tissue overgrowth, inflammatory changes, or other structures compressing the nerve,
• diagnostically confirmed tarsal tunnel syndrome.

Not every patient with foot pain or numbness requires surgery. Accurate diagnosis and identification of the true cause of symptoms remain essential.

Convalescence

Recovery after tarsal tunnel release is gradual and depends on the severity of the condition and the nerve’s response to treatment.

During the initial recovery period, patients are usually advised to:

• limit weight-bearing activities,
• protect the operated area,
• gradually increase activity levels,
• participate in rehabilitation aimed at supporting nerve recovery and restoring proper foot function.

Because nerves regenerate slowly, symptom improvement may not be immediate and can continue progressively over time.

The recovery process is planned individually and depends on the degree of nerve irritation before surgery, symptom duration, healing progress, and adherence to post-operative recommendations.

Precautions

Long-term nerve compression can lead to permanent nerve damage.

If treatment is delayed, patients may develop:

• worsening sensory disturbances,
• chronic pain,
• reduced foot function,
• permanent impairment of nerve conduction.

Early diagnosis and appropriate treatment generally improve the chances of nerve recovery and help prevent long-term complications.

Tarsal tunnel syndrome may be difficult to diagnose because its symptoms can resemble other foot, ankle, or spinal conditions. Therefore, identifying the true source of symptoms is a key part of treatment planning.

Surgery is generally considered when symptoms persist despite appropriate therapy or begin to significantly affect quality of life and daily activities.

Benefits

The main goal of tarsal tunnel release is to reduce pressure on the tibial nerve and improve its function.

Potential benefits include:

• reduced pain,
• improvement or resolution of numbness and tingling,
• improved nerve conduction,
• increased walking comfort,
• greater freedom in daily activities,
• improved foot function,
• better everyday mobility,
• improved quality of life.

Treatment outcomes depend on factors such as symptom duration, the degree of nerve irritation before surgery, and the patient’s individual healing response.

Nerves do not tolerate prolonged compression well, so earlier diagnosis and appropriate treatment may improve the chance of preserving nerve function and restoring walking comfort.

What is tarsal tunnel release?

Tarsal tunnel release is a surgical procedure performed to relieve compression of the tibial nerve along the inner side of the ankle.

The goal is to reduce pressure on the nerve, relieve pain, improve nerve function, and restore normal foot function.

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What is the tarsal tunnel?

The tarsal tunnel is a narrow anatomical passage located on the inner side of the ankle.

The tibial nerve and accompanying structures pass through this space. When the nerve becomes compressed, symptoms such as pain, tingling, burning, numbness, or radiating sensations may occur.

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How is the procedure performed?

During surgery, the surgeon releases the tibial nerve from areas of compression, divides structures causing excessive tension, enlarges the tarsal tunnel space, and removes tissue or pathological changes compressing the nerve.

The aim is to improve the environment around the nerve and restore normal nerve conduction.

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When should tarsal tunnel release be considered?

The procedure is most commonly considered in patients with symptoms of tarsal tunnel syndrome that persist despite conservative treatment.

These symptoms may include pain along the inner ankle or sole of the foot, numbness, tingling, burning, electric shock-like sensations radiating into the toes, worsening symptoms during walking or prolonged standing, and reduced sensation in the foot.

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What results can be expected after surgery?

The primary goal is to reduce pressure on the nerve and improve its function.

Patients may experience reduced pain, improvement or resolution of numbness and tingling, increased walking comfort, and greater freedom in daily activities.

Treatment outcomes depend on symptom duration and the degree of nerve irritation before surgery.

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Why should treatment not be delayed?

Long-term nerve compression can lead to permanent nerve damage.

Over time, patients may develop worsening sensory disturbances, chronic pain, reduced foot function, and permanent impairment of nerve conduction.

Early diagnosis and appropriate treatment can improve the chances of nerve recovery.

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How is the treatment approach selected?

Treatment is selected individually after careful evaluation.

The qualification process may include clinical examination, imaging studies, nerve conduction studies such as EMG, and assessment of foot and ankle biomechanics.

Surgery is usually considered when rehabilitation, anti-inflammatory therapy, or activity modification do not provide sufficient improvement.

Is surgery always necessary?

No. In earlier stages, conservative treatment may be effective.

This can include rehabilitation, anti-inflammatory treatment, reducing foot strain, custom orthotic insoles, and activity modification.

Surgery is usually considered when symptoms persist despite treatment, pain and sensory disturbances worsen, or the condition begins to interfere with daily functioning.

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What does recovery involve?

Recovery is gradual and depends on the severity of the condition and the nerve’s response to treatment.

Patients are usually advised to limit weight-bearing activities, protect the operated area, gradually increase activity levels, and participate in rehabilitation aimed at supporting nerve recovery and restoring foot function.

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Why may symptom improvement take time?

Nerves regenerate slowly, so improvement after surgery may not be immediate.

Symptoms can continue to improve progressively over time, depending on the degree of nerve compression before surgery and the patient’s individual healing response.

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What are the indications for tarsal tunnel release?

The procedure may be indicated in cases of chronic pain along the inner ankle or sole of the foot, numbness, tingling, burning sensations, symptoms radiating into the toes, impaired tibial nerve function, persistent symptoms despite conservative treatment, or diagnostically confirmed tarsal tunnel syndrome.

How is a patient qualified for surgery?

Qualification is based on a comprehensive specialist assessment.

This may include orthopaedic consultation, clinical examination, imaging studies, nerve conduction testing, assessment of foot and ankle biomechanics, and review of previous conservative treatment.

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Why is accurate diagnosis important?

Tarsal tunnel syndrome can be difficult to diagnose because its symptoms may resemble other foot, ankle, or spinal conditions.

Accurate diagnosis helps identify the true source of symptoms and select the most appropriate treatment strategy.