Tarsal Tunnel Syndrome
Tarsal tunnel syndrome is compression of the posterior tibial nerve as it passes through the tarsal tunnel—a narrow passage on the inner side of the ankle beneath the flexor retinaculum (a fibrous band of tissue). The nerve and its branches supply sensation to the bottom of the foot and motor function to some intrinsic foot muscles. The condition is sometimes called the foot equivalent of carpal tunnel syndrome, though it is far less common and can be caused by a wider variety of compressive lesions including varicose veins, ganglion cysts, bone spurs, tendon sheath swelling, or flat foot deformity that narrows the tunnel.
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Symptoms
- Burning, tingling, or electric shock sensations along the inner ankle and into the arch or toes
- Numbness on the bottom of the foot
- Pain that worsens with prolonged standing or walking and improves with rest
- Symptoms that may radiate up the calf (proximal radiation) or into the toes
- Tenderness to palpation behind the medial malleolus (inner ankle bone)
- Positive Tinel sign: tapping over the tibial nerve behind the ankle reproduces tingling into the foot
When to See a Doctor
See a foot and ankle specialist if you have burning or tingling on the bottom of your foot combined with ankle-area tenderness, especially if symptoms are not responding to rest. Electrodiagnostic testing (nerve conduction study) helps confirm the diagnosis and rule out lumbar spine or systemic causes.
Treatment Options
Conservative management
Custom orthotics to correct flat foot deformity, supportive footwear, activity modification, NSAIDs for inflammation, and sometimes a short course of oral steroids or a cortisone injection into the tarsal tunnel.
Physical therapy
Neural mobilization techniques, intrinsic foot strengthening, and stretching of the Achilles and plantar fascia can reduce nerve tension and provide relief in mild cases.
Tarsal tunnel release surgery
The flexor retinaculum is divided to decompress the tibial nerve and its branches. When a space-occupying lesion (cyst, varicosity, bone spur) is identified, it is removed at the same time. Outcomes are best when a discrete compressive cause is identified preoperatively—diffuse cases without identifiable lesions have more variable results.
Recovery Timeline
Conservative treatment: improvement over 4–8 weeks if an underlying cause (flat foot, inflammation) is addressed. Surgical decompression: protected weight-bearing for 2–3 weeks, return to full activity in 6–8 weeks. Nerve recovery after surgery can be gradual—some patients continue to improve for 6–12 months post-operatively.
Frequently Asked Questions
How is tarsal tunnel syndrome different from plantar fasciitis?
Both cause bottom-of-foot pain, but the character and pattern differ. Plantar fasciitis is typically worst with the first steps in the morning and eases with walking; it is a tearing pain at the heel attachment. Tarsal tunnel syndrome produces burning and tingling that worsens with prolonged activity; it is a nerve pain rather than a mechanical pain. Tinel sign (tingling with tapping behind the ankle) helps distinguish the two.
Can flat feet cause tarsal tunnel syndrome?
Yes. Flat foot (pes planus) causes valgus alignment of the hindfoot, which stretches and displaces the tibial nerve within the tarsal tunnel. Correcting the flat foot with orthotics or, in severe structural cases, with flatfoot reconstruction surgery, can relieve the nerve compression.
What type of doctor treats tarsal tunnel syndrome?
Foot and ankle orthopaedic surgeons and podiatrists both diagnose and treat tarsal tunnel syndrome. Neurologists may be involved in electrodiagnostic testing. Because the condition can mimic lumbar radiculopathy and diabetic neuropathy, a clear workup ruling out those diagnoses is important before committing to surgery.
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This information is for educational purposes only and is not a substitute for professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.