Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is a painful foot condition characterized by the posterior tibial nerve being compressed or pinched in the tarsal tunnel passage located on the inside, medial area of the ankle. It often creates a tingly, burning feeling in the ankles, feet and lower legs.


Most people with tarsal tunnel syndrome (sometimes called posterior tibial neuralgia) complain about a burning sensation in the toes, arches of the feet and heel that radiates up to the knees. Numbness and tingly pins and needles sensation is often present when the tibial nerve is trapped, as well. These symptoms are often worse during running, standing for long periods of time and while trying to sleep at night.

Fluid collect can collect in the foot when standing and walking, which makes the tarsal tunnel condition worse. A cramping feeling can also result as small muscles lose their nerve supply.


Sometimes tarsal tunnel syndrome is confused for plantar fasciitis, which also creates foot pain in the heel and arch of the foot.


Tarsal tunnel syndrome happens when the tibial nerve in your foot becomes compressed, pinched or trapped. This can happen due to a number of things, including:

  • Flat feet or high arch foot (both of which interfere with a person’s natural gait)
  • Over pronation (when a person’s feet roll inward during walking and running)
  • Ankle or tendon swelling
  • Rheumatoid arthritis
  • Diabetes (which can cause swelling and neuropathy that crush the tibial nerve)
  • A cyst in the tarsal tunnel
  • An enlarged varicose vein
  • Tenosynovitis (inflammation of the fluid-filled sheaths that surround tendons)
  • Talonavicular coalition (the fusing of two tarsal bones)
  • Neurofibromatosis (a disease that results in the formation of pigmented cutaneous neurofibromas)


Most cases of tarsal tunnel syndrome are caused by over pronation, especially in people who frequently run or engage in sports. Over pronation is generally caused by flat feet and other common foot deformities.


If you suspect you may have tarsal tunnel syndrome, you should make an appointment with your podiatrist for an official diagnosis. He or she can evaluate if you are in fact experiencing tarsal tunnel syndrome symptoms or a different type of foot pain.

Most cases of tarsal tunnel syndrome can be treated with plenty of rest and rehabilitation. Your doctor may prescribe an anti-inflammatory medication to help pain and swelling and/or recommend using ice or heat therapy to help reduce the pain.

After a brief period of rest, tarsal tunnel syndrome treatment is usually then followed up with a rehabilitation program that includes various stretching exercises to help relax and strengthen the foot muscles, tendons and ligaments — especially those on the medial (or middle) part of the inside of the affected foot. 

If rest and stretching exercises do not help, your doctor may begin nerve conduction studies to help locate the nerve entrapment and see if arthritis, a cyst of tarsal coalition may be to be blame. He or she may also recommend a corticosteroid injection or surgery to help decompress the nerve. However, the success rate of this type of surgery is mixed and comes with a high risk of complications, so conservative treatment methods are usually preferred.

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