Overview
Tarsal tunnel syndrome is a nerve problem that happens when the posterior tibial nerve gets compressed as it passes through the tarsal tunnel near the inside of the ankle. This nerve supplies sensation to the sole and part of the foot and helps control some small foot muscles. Compression and irritation of the nerve can lead to burning pain, tingling, numbness, and sometimes weakness. Because similar symptoms can come from other nerve or foot conditions, a focused exam is important to confirm the source.
Symptoms
Symptoms are usually felt in the sole of the foot, heel area, and sometimes into the toes, often with burning, tingling, or numbness. Many people notice symptoms worsen with standing, walking, or wearing tight or unsupportive shoes, and they may feel night pain. As the condition progresses, sensation can become dulled and some patients develop weakness of foot muscles, which may affect balance and walking. Symptoms can come and go early on, but can become more persistent if the nerve stays compressed.
Causes
Tarsal tunnel syndrome typically develops from compression of the posterior tibial nerve within the tarsal tunnel. This compression can be caused by swelling or inflammation, thickening of nearby tissues, ankle/foot arthritis, trauma or scarring, or space-occupying lesions such as a ganglion cyst. Foot biomechanics like flatfoot (excess pronation) can increase tension and strain around the tunnel, making nerve irritation more likely.
Risk Factors
Risk is higher in people with flat feet or significant foot pronation because the tunnel area can be stressed. Diabetes or other conditions that affect nerves increase susceptibility to neuropathy and make nerve irritation easier to sustain. Inflammatory arthritis, prior ankle injury, and chronic swelling can also raise the chance of entrapment. People who are overweight or who do repetitive standing or long-distance walking may be at greater risk due to increased loading on the ankle and foot.
Prevention
You can lower risk by supporting foot mechanics with appropriate footwear and, when needed, arch-supporting orthotics. Avoid tight shoes and ensure your shoes fit well, especially around the heel and ankle, to reduce local nerve irritation. Gradually build activity, strengthen the lower leg and calf muscles, and stretch the Achilles as recommended by a clinician or physical therapist. Managing body weight and keeping blood sugar under control can also reduce the likelihood of nerve problems.
How the Diagnosis Is Evaluated
Clinicians usually start with a detailed history about where symptoms occur and what makes them worse, including whether pain or numbness travels into the toes or sole. A physical exam focuses on nerve sensation changes in the sole, muscle strength of the foot, assessment of foot alignment (such as flatfoot), and a provocative test such as tapping over the tarsal tunnel (often called Tinel sign). Imaging like ultrasound or MRI may be used if a mass, tendon problem, or arthritis is suspected. Nerve testing (EMG and nerve conduction studies) can help confirm posterior tibial nerve dysfunction and rule out other neuropathies, and not every patient needs every test.
Nonsurgical Treatment Options
Conservative care aims to reduce nerve compression and calm nerve irritation. Most treatment plans begin with activity modification, supportive footwear, and orthotics when biomechanical issues like flatfoot are contributing. Anti-inflammatory medications such as NSAIDs may help with pain if appropriate for you, and physical therapy can focus on calf stretching, improving ankle mechanics, and addressing foot alignment. A clinician may recommend a corticosteroid injection around the tarsal tunnel to reduce inflammation and pain when symptoms persist despite initial measures. In some chronic cases, platelet-rich plasma (PRP) injections may be considered, though the evidence base is still evolving. If symptoms are strongly neuropathic, medication for nerve pain may also be used as directed by a clinician while the underlying cause is addressed.
When to Seek Medical Attention
Seek prompt medical evaluation if numbness or burning is worsening, if you develop noticeable weakness in the foot, or if symptoms persist despite several weeks of conservative care. Get urgent care if you cannot bear weight, if you have rapidly progressive neurologic symptoms, or if there is major swelling with fever or redness that could suggest infection. Also seek timely care if you have sudden loss of function or severe pain that is out of proportion, especially after an injury.
Frequently Asked Questions
It commonly causes burning pain, tingling, or numbness along the sole of the foot and into the toes.
Many people improve with conservative treatment such as supportive footwear, orthotics, physical therapy, and sometimes a corticosteroid injection.
Next Steps
If your symptoms match nerve irritation in the sole and worsen with standing or walking, schedule a clinical evaluation to identify the exact cause and start targeted conservative care. If you notice progressive numbness, new weakness, or difficulty walking, seek assessment sooner rather than later.