Tarsal tunnel syndrome (TTS) is the ankle equivalent of carpal tunnel syndrome: compression of the tibial nerve within the tarsal tunnel (behind the medial malleolus) produces pain, tingling, and numbness in the sole of the foot and sometimes the toes. Unlike plantar fasciitis, which is a morning pain condition, TTS produces symptoms that often worsen with prolonged standing and walking -- making it a condition where reducing walking load is directly relevant.
How TTS Produces Walking Symptoms
The tibial nerve passes through the tarsal tunnel along with tendons, arteries, and veins. During walking, the ankle repeatedly moves through dorsiflexion and plantarflexion cycles, and the tarsal tunnel contents experience compression variation with each step. In TTS, this compression is already pathologically increased -- additional compression from prolonged weight-bearing amplifies symptoms.
A walking cane reduces the total stance-phase force through the affected foot, reducing the compression cycle with each step. This is not the same as eliminating the nerve compression, but it reduces the repetitive mechanical aggravation that prolonged walking creates.
Which Side for TTS
TTS is typically unilateral (one ankle affected). Cane on the contralateral side (opposite the affected ankle) reduces the load through the affected foot during each step. The cane advances simultaneously with the affected leg, providing a load-sharing point during the stance phase on the symptomatic side.
Orthotic Insoles and Cane Use
TTS is often managed with orthotic insoles to reduce pronation (which increases tarsal tunnel pressure). If orthotic insoles are used, they add height to the shoe (typically 3-8mm). Cane height should be assessed with the orthotic in the shoe, not without -- a 5mm orthotic requires approximately 3-4mm upward adjustment to the cane height to maintain the correct elbow angle.
Differentiation from Plantar Fasciitis
Both TTS and plantar fasciitis produce foot pain. Key clinical differences affecting cane use:
| Feature | Tarsal Tunnel Syndrome | Plantar Fasciitis |
|---|---|---|
| Pain location | Medial ankle and sole, may radiate to toes | Medial heel, morning worst |
| Timing | Worsens with prolonged walking/standing | Worst first steps in morning, improves then worsens |
| Character | Burning, tingling, numbness | Sharp stabbing or aching |
| Tinel sign | Positive (tapping behind medial malleolus reproduces symptoms) | Negative typically |
| Cane utility | Reduces repetitive compression aggravation | Reduces heel loading |
Recovery Trajectory
TTS of mild to moderate severity often resolves with conservative management: orthotic insoles, activity modification, local corticosteroid injection, and physiotherapy. Cane use during this conservative management period reduces the walking-related aggravation and supports the overall load reduction strategy. For severe TTS requiring surgical decompression, post-operative weight-bearing protocols apply.
The DaiWalk range with collet mechanism allows precise height adjustment when using cane alongside orthotic insoles -- important for correct elbow angle throughout the recovery period.
