Tarsal tunnel syndrome

Tarsal tunnel syndrome develops when a nerve near the inner ankle becomes compressed, causing pain, burning or tingling that can spread into the foot. This condition can make standing, walking or even resting uncomfortable. With the right diagnosis and care plan, most people find relief and get back to moving comfortably.

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Anatomy of the foot and ankle

The tarsal tunnel is a narrow passageway located behind the inner ankle bone. It's formed by bones and a band of ligament, and it houses the posterior tibial nerve along with an artery and several tendons. This nerve helps control feeling and movement in your foot.

Much like carpal tunnel syndrome affects the wrist, tarsal tunnel syndrome occurs when something inside this tunnel puts pressure on the nerve. Swelling, injury, flat feet or repetitive stress can all tighten the space around the nerve. Over time, that pressure can worsen, leading to more noticeable symptoms and, if left unaddressed, weakness in the muscles of the foot.

Overview

Symptoms

You may have tarsal tunnel syndrome if you notice:

Burning, tingling or electric shock sensations in the inner ankle, arch or toes
Pain that worsens at night or after standing or walking for long periods
Numbness in the sole of the foot
Shooting pain toward the heel or toes when the inner ankle is tapped
Weakness or cramping in the muscles of the foot

Symptoms often develop gradually, but they can flare up with activity, tight shoes or weight gain.

Causes

Common causes of tarsal tunnel syndrome include:

Foot structure or mechanics: Flat arches or feet that roll inward can increase pressure on the nerve
Ankle sprains or injury: Swelling from a sprain or other trauma can press on the nerve
Repetitive stress: Running or jobs that require long periods of standing can tighten the tissue around the nerve
Cysts or growths: Small lumps or tumors in the tunnel can irritate the nerve
Inflammation: Conditions such as arthritis, tendonitis or varicose veins can cause swelling that presses on the nerve

Risk factors

Certain factors may raise your risk of developing tarsal tunnel syndrome, including flat feet or fallen arches, a history of ankle injury, jobs or activities that involve repetitive standing or walking and inflammatory conditions like arthritis. Having one or more of these risk factors does not mean you'll develop the condition, but it's helpful to share them with your care team.

Diagnosis

Our foot and ankle specialists diagnose tarsal tunnel syndrome by evaluating your symptoms, activity level and footwear. This typically includes a physical exam that involves pressing along the tarsal tunnel and testing nerve function, along with Tinel's sign test, which checks for tingling when the inner ankle is tapped. Depending on your symptoms, nerve conduction studies or electromyography (EMG) may be used to measure how well the nerve is working. X-rays or ultrasound can help rule out structural causes like cysts or fractures, and a gait analysis may be used to assess how your foot mechanics could be contributing to nerve pressure.

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We offer leading-edge treatments for most foot and ankle conditions, treating many with medications, bracing and injections.

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