What to Know About Tarsal Tunnel Syndrome

Foot and ankle pain can make everyday activities—like walking, standing, or exercising—far more difficult than they should be. One lesser-known but often overlooked cause of foot pain is tarsal tunnel syndrome. Because its symptoms can mimic other foot conditions, many people live with discomfort longer than necessary before receiving the correct diagnosis.

Understanding what tarsal tunnel syndrome is, how it develops, and what treatment options are available can help you seek care sooner and protect long-term nerve health.

What Is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome occurs when the posterior tibial nerve becomes compressed or irritated as it passes through the tarsal tunnel, a narrow passageway located on the inside of the ankle. This tunnel is formed by bones and a thick ligament, leaving little room for swelling or structural changes.

When pressure builds within the tunnel, the nerve can become inflamed, leading to pain, tingling, or numbness in the foot and ankle.

Common Symptoms of Tarsal Tunnel Syndrome

Symptoms may vary in severity and often worsen with prolonged standing or walking. Common signs include:

• Tingling, burning, or “pins and needles” sensations in the foot
• Numbness along the sole of the foot or toes
• Shooting pain that radiates from the ankle into the arch or heel
• Aching or cramping in the foot
• Symptoms that worsen at night or after activity

Because these symptoms overlap with plantar fasciitis, peripheral neuropathy, and other foot conditions, tarsal tunnel syndrome is sometimes misdiagnosed.

What Causes Tarsal Tunnel Syndrome?

Anything that reduces space within the tarsal tunnel can place pressure on the nerve. Common causes include:

• Flat feet or fallen arches, which stretch the nerve
• Ankle injuries such as sprains or fractures
• Swelling from arthritis or inflammatory conditions
• Ganglion cysts, bone spurs, or varicose veins
• Repetitive stress from high-impact activities

In some cases, no single cause is identified, and symptoms develop gradually over time.

How Is Tarsal Tunnel Syndrome Diagnosed?

Diagnosis begins with a thorough medical history and physical examination. A provider may check for tenderness along the inside of the ankle or reproduce symptoms by tapping over the nerve.

Additional diagnostic tools may include:

• Nerve conduction studies to assess nerve function
• Ultrasound or MRI to identify structural causes such as cysts or inflammation
• Gait and foot alignment assessment

Early diagnosis is important, as prolonged nerve compression can lead to permanent nerve damage.

Treatment Options for Tarsal Tunnel Syndrome

Treatment depends on symptom severity, duration, and the underlying cause. Most patients begin with conservative therapies before considering advanced interventions.

Conservative treatment options may include:

• Activity modification to reduce nerve irritation
• Supportive footwear or custom orthotics
• Physical therapy to improve foot mechanics
• Anti-inflammatory strategies and targeted stretching

Interventional and advanced treatments may include:

• Image-guided injections to reduce inflammation around the nerve
• Minimally invasive procedures when conservative care fails
• Surgical decompression in severe or persistent cases

A personalized treatment plan focused on relieving pressure on the nerve offers the best chance for symptom improvement.

Can Tarsal Tunnel Syndrome Become Chronic?

Yes. If left untreated, ongoing nerve compression may lead to chronic pain, persistent numbness, or muscle weakness in the foot. Early intervention improves outcomes and may help prevent long-term complications.

When Should You Seek Care?

You should consider evaluation if you experience:

• Persistent foot tingling or burning
• Pain that interferes with walking or daily activities
• Symptoms that worsen over time or do not improve with rest

Prompt evaluation allows for earlier treatment and better long-term nerve health.

Final Thoughts

Tarsal tunnel syndrome is an underrecognized cause of foot and ankle pain, but it is highly treatable when identified early. If foot pain, tingling, or numbness is limiting your mobility, a comprehensive evaluation can help determine whether nerve compression is the underlying cause and guide appropriate treatment options.