Tarsal Tunnel Syndrome Explained: Diagnosis and Treatment Options

Most people have heard of carpal tunnel syndrome in the wrist — but far fewer know that a very similar condition can happen in the foot. It’s called Tarsal Tunnel Syndrome (TTS), and it can cause burning, tingling, numbness, and shooting pain that travels from the inside of the ankle into the arch, heel, and toes.

At Restore Foot & Ankle Specialists, we often see patients who have been misdiagnosed or didn’t realize nerve compression could happen in the foot. Understanding tarsal tunnel syndrome is the first step toward finding relief — and preventing long-term nerve damage.

What Is Tarsal Tunnel Syndrome?

The tarsal tunnel is a narrow space located on the inside of the ankle, covered by a thick ligament called the flexor retinaculum. Inside this tunnel run:

• The tibial nerve

• Arteries

• Veins

• Tendons

When the tibial nerve becomes compressed or irritated as it passes through this tight space, it leads to Tarsal Tunnel Syndrome.

Because the tunnel is rigid and confined, even minimal swelling or pressure can trigger significant symptoms.

What Causes Tarsal Tunnel Syndrome?

There are several reasons the tibial nerve can become compressed:

1. Flat Feet (Overpronation)

One of the most common causes. When the arch collapses, the heel rotates inward and stretches the tibial nerve, narrowing the tunnel.

2. Ankle Injuries

Sprains, fractures, and chronic instability can cause inflammation or scar tissue buildup around the nerve.

3. Space-Occupying Lesions

These include:

• Ganglion cysts

• Lipomas

• Varicose veins

• Bone spurs

Any growth inside the tunnel increases pressure on the nerve.

4. Systemic Conditions

Diseases that cause swelling or nerve sensitivity — including diabetes, arthritis, and peripheral neuropathy — can contribute to symptoms.

5. Overuse Stress

High-impact activities, prolonged standing, or repetitive movements can worsen nerve irritation.

Symptoms of Tarsal Tunnel Syndrome

Symptoms vary depending on the severity of nerve compression, but they often include:

• Burning or tingling in the arch or heel

• Electric shock sensations

• Numbness in the bottom of the foot

• Sharp, shooting pain into the toes

• Worsening pain during or after activity

• Pain that radiates up the leg

• Increased symptoms at night

One hallmark sign is a positive Tinel’s sign — a tingling sensation when the nerve is tapped along the inside of the ankle.

Why Early Diagnosis Is Important

The tibial nerve is responsible for sensation and motor control in the bottom of the foot. When compression is prolonged, it can lead to:

• Chronic pain

• Loss of sensation

• Muscle weakness

• Permanent nerve damage

Diagnosing and treating the condition early leads to much better outcomes.

How Tarsal Tunnel Syndrome Is Diagnosed

A podiatrist will evaluate:

• Your foot structure (flat feet, high arches, abnormal alignment)

• Range of motion and gait

• Localized tenderness

• Nerve sensitivity (including Tinel’s sign)

Diagnostic tools may include:

• Ultrasound to evaluate soft tissue structures

• X-rays to detect bone abnormalities

• MRI for cysts or inflammatory conditions

• Nerve conduction studies in complex cases

Treatment Options for Tarsal Tunnel Syndrome

Fortunately, many patients improve with non-surgical care, especially when treated early.

1. Orthotics for Arch Support

Custom or supportive orthotics help reposition the foot, reduce overpronation, and relieve tension on the tibial nerve.

2. Anti-Inflammatory Treatment

Options include:

• NSAIDs

• Topical anti-inflammatory creams

• Ice therapy

• Physical therapy modalities

3. Immobilization

A boot or brace may be used temporarily to reduce nerve irritation.

4. Corticosteroid Injections

Targeted injections around the nerve help reduce inflammation and provide short-term relief.

5. Physical Therapy

Therapists focus on:

• Calf and Achilles stretching

• Nerve glides

• Strengthening the posterior tibial tendon

• Improving foot and ankle mechanics

6. Activity Modification

Limiting prolonged standing, high-impact exercise, or uneven terrain can ease symptoms.

When Surgery Is Considered

Surgery is recommended when:

• Symptoms persist despite several months of conservative care

• Nerve conduction studies show significant compression

• A mass (cyst, bone spur, or varicosity) is crowding the tunnel

• Pain progressively worsens

Tarsal Tunnel Release is the most common procedure. During surgery, the surgeon opens the flexor retinaculum to decompress the tibial nerve and remove any structures causing pressure.

Patients typically recover well with physical therapy and supportive footwear.

Preventing Tarsal Tunnel Syndrome

Protecting your feet from nerve compression is possible with a few proactive steps:

• Wear shoes with proper arch support

• Avoid worn-out footwear

• Stretch calves and ankles daily

• Manage flat feet with orthotics

• Strengthen the ankles and intrinsic foot muscles

• Address injuries promptly instead of “working through pain”

The Bottom Line

Tarsal Tunnel Syndrome is often overlooked or mistaken for plantar fasciitis or neuropathy — but when properly diagnosed, it can be treated effectively. Whether you’re feeling burning, tingling, or numbness in the bottom of your foot, a podiatrist can help identify the cause and build a personalized treatment plan.

At Restore Foot & Ankle Specialists, we specialize in biomechanical evaluation, nerve compression management, and advanced treatment for foot and ankle conditions.

If you’re experiencing persistent tingling, numbness, or burning in your foot, schedule an evaluation today — early treatment makes all the difference.  Contact our office today with Dr. Gireesh Reddy or Dr. Sirisha Pokala by calling (469) 573-3427 or by booking an appointment online.