Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome: Treatment in Palm Beach

Tarsal tunnel syndrome involves compression of the posterior tibial nerve as it passes through the tarsal tunnel behind and below the inner ankle. It produces foot and ankle pain, numbness, and tingling that is frequently misdiagnosed as plantar fasciitis, delaying effective treatment.

Dr. Ghattas's neurological expertise and proficiency with lower extremity nerve hydrodissection make Palm Beach Regenerative well-suited to accurately diagnose and treat tarsal tunnel syndrome. Contact us today to schedule an appointment at Palm Beach Regenerative.

What Is Tarsal Tunnel Syndrome?

The tarsal tunnel is a narrow passageway formed by the ankle bones and the flexor retinaculum ligament on the inner ankle. The posterior tibial nerve, along with tendons and blood vessels, passes through this tunnel. Compression or irritation of the nerve here produces the characteristic symptoms of tarsal tunnel syndrome.

Signs and Symptoms

• Burning, tingling, or numbness on the bottom of the foot and toes
• Symptoms that may radiate from the inner ankle down into the arch and heel
• Pain that worsens with prolonged standing, walking, or activity
• Tenderness and a positive Tinel's sign with percussion behind the inner ankle
• Symptoms that may worsen at night in some cases

Common Causes and Risk Factors

• Flat feet (overpronation) increasing tension on the posterior tibial nerve
• Prior ankle fracture, sprain, or surgery creating scar tissue
• Space-occupying lesions within the tarsal tunnel (cysts, lipomas)
• Systemic conditions affecting nerve health (diabetes, hypothyroidism)
• Prolonged standing or walking on hard surfaces

How It Is Diagnosed

Electrodiagnostic testing (nerve conduction studies of the medial and lateral plantar nerves) objectively confirms posterior tibial nerve dysfunction and distinguishes tarsal tunnel syndrome from plantar fasciitis and peripheral neuropathy.

Ultrasound allows direct visualization of the posterior tibial nerve at the tarsal tunnel and identifies any space-occupying lesions contributing to compression.

Conventional Treatment Options

• Orthotic arch support to reduce nerve tension from overpronation
• Anti-inflammatory medications and nerve pain agents
• Corticosteroid injection into the tarsal tunnel
• Surgical tarsal tunnel release for confirmed entrapment with adequate trial of conservative care

The Palm Beach Regenerative Approach

Dr. Ghattas uses real-time ultrasound-guided posterior tibial nerve hydrodissection at the tarsal tunnel, delivering targeted platelet preparation around the nerve to reduce perineural inflammation and free compressive adhesions.

Accurate diagnosis differentiating tarsal tunnel syndrome from plantar fasciitis ensures that treatment is directed at the correct structure, which is the most important factor in achieving relief.

The BioMod Advantage: MLS Robotic Laser Therapy applied to the inner ankle and foot reduces posterior tibial nerve inflammation and the surrounding soft tissue that compresses the tarsal tunnel. Xymogen nerve support and anti-inflammatory protocols provide systemic support for nerve recovery and reduce the inflammatory burden on the tarsal tunnel.

Like all medical procedures, orthobiologic treatments have potential risks and benefits. Results vary by individual. Not all patients are candidates. Dr. Ghattas will discuss your specific situation, realistic expectations, and all treatment options, including when surgery or other interventions may be more appropriate.