- Tarsal tunnel syndrome is nerve compression — the foot's equivalent of carpal tunnel.
- It causes burning, tingling, electrical pain or numbness on the inside of the ankle and along the bottom of the foot.
- Symptoms typically worsen with activity and improve with rest — opposite of plantar fasciitis.
- Most patients improve with bracing, custom orthotics, nerve-pain medication, and physical therapy.
- Surgical release is highly effective for patients who fail conservative care or have a clearly identified mass causing compression.
What is tarsal tunnel syndrome?
Tarsal tunnel syndrome is compression of the posterior tibial nerve as it passes through the tarsal tunnel — a narrow space behind the inside ankle bone. When that nerve is compressed, it sends abnormal signals to the foot: burning, tingling, electrical shocks, numbness, or aching that radiates into the arch and sometimes the toes. It's the lower-extremity equivalent of carpal tunnel syndrome in the wrist.
Causes vary widely. It can be triggered by a fallen arch (chronic stretch on the nerve), a ganglion cyst or varicose vein pushing on the nerve, a previous ankle fracture, swelling from systemic conditions like diabetes or hypothyroidism, or sometimes for no identifiable reason. Because the symptoms overlap with plantar fasciitis and peripheral neuropathy, the diagnosis is frequently missed.
At NES, we evaluate every patient with burning or shooting foot pain for tarsal tunnel specifically. The clinical exam — Tinel's sign at the inside ankle — is often diagnostic. Conservative care works for most patients; surgical release is highly effective for those who fail conservative care or have a clear mechanical cause.
See it in motion
Animations licensed from ViewMedica · Swarm Interactive
What it feels like
Tarsal tunnel syndrome has a distinctive nerve-pain pattern. Common symptoms:
- Burning, tingling, or electrical-shock pain on the inside of the ankle
- Pain or numbness radiating into the arch and sometimes the toes
- Symptoms that worsen with prolonged standing, walking, or running
- Symptoms that improve with rest, elevation, or removing the shoe (opposite of plantar fasciitis)
- A positive "Tinel's sign" — tapping behind the inside ankle reproduces the shooting pain
- Symptoms that wake you up at night or are worse at the end of the day
Why it develops
Tarsal tunnel syndrome has many possible causes. Common contributors:
- A collapsed arch (PTTD or flat foot) that stretches the nerve chronically
- A ganglion cyst, lipoma, or varicose vein within the tunnel pressing on the nerve
- Previous ankle fracture or sprain that scarred the tunnel
- Systemic conditions causing fluid retention — diabetes, hypothyroidism, pregnancy
- Inflammatory arthritis (rheumatoid)
- Repetitive ankle stress in runners and dancers
- Idiopathic — about a third of cases have no identifiable cause
How we diagnose tarsal tunnel syndrome
Diagnosis starts with a careful history (the symptom pattern is usually diagnostic) and physical exam. The Tinel's sign — reproducing the shooting pain by tapping over the nerve behind the inside ankle — is often positive. Nerve conduction studies (NCS) and electromyography (EMG) confirm the diagnosis and rule out peripheral neuropathy. MRI is used selectively to look for mass lesions inside the tunnel that might need surgical removal.
Non-surgical care
Conservative care helps most patients, particularly those without a mass lesion:
- Custom orthotics, often with a medial arch support and medial heel post, to reduce nerve stretch
- Ankle brace or boot for a short period in severe cases
- Nerve-pain medication (gabapentin, pregabalin) for symptom control
- Physical therapy with nerve gliding exercises
- Treatment of the underlying contributor (e.g., aggressive flatfoot bracing, glycemic control for diabetics)
- Corticosteroid injection into the tunnel for inflammatory cases (used selectively)
- Activity modification — reducing impact loading until symptoms calm
Surgical care
Surgical release of the tarsal tunnel is highly effective for patients who fail conservative care or who have a clear compressive lesion.
- Open tarsal tunnel release — division of the flexor retinaculum to decompress the nerve
- Removal of any mass lesion (ganglion cyst, varicose veins, lipoma) found during the release
- Endoscopic tarsal tunnel release in selected cases
Recovery from tarsal tunnel release is generally fast: light weight-bearing in a post-op shoe for 2 weeks, sutures out at 10–14 days, transition to supportive shoes, and return to most activity at 6–8 weeks. Full nerve recovery can take months — the nerve heals slowly.
When to see a specialist
- Burning or shooting foot pain that has lasted more than 3–4 weeks
- Pain that's wrong for plantar fasciitis (worse with activity, better with rest)
- Numbness or tingling in the arch, heel, or toes
- Foot pain after an ankle injury that has not resolved
Tarsal tunnel syndrome is treated by every NES podiatrist. Diagnostic NCS/EMG is coordinated with our partner neurology lab. Surgical release is performed by Dr. Yama Dehqanzada, Dr. Thomas Melillo, and Dr. Mia Horvath.