What it is

The tarsal tunnel, located on the inside of the ankle, is lined with a thick ligament (retinaculum) that maintains the structures within the tunnel, including nerves, tendons, and blood vessels. Tarsal tunnel syndrome occurs when the posterior tibial nerve, which passes through this narrow space along the inner ankle, becomes entrapped.

Due to this compression, people describe experiencing pain, with symptoms including burning, tingling, or numbness, typically in the sole and heel of the foot, which worsens with standing and walking. Still, they can extend as far as the toes and into the calf muscle,

Flatfoot posture, swelling, ganglion cysts, scar tissue from previous injuries and surgery, and bony deformities, such as bone spurs, can all narrow the tunnel. Night pain can occur. Untreated nerve compression can lead to persistent symptoms and changes in gait.

With offloading, mobility work, and selective activity changes, symptoms often settle. Surgical decompression is reserved for confirmed entrapment with neurological change.

What happens when it occurs

Mechanical compression and reduced blood flow irritate the nerve.

Correcting foot posture and reducing local pressure restores nerve gliding.

Common causes and risk factors

  • Flatfoot alignment and prolonged pronation
  • Post-trauma scarring or space-occupying lesions
  • Diabetes and other metabolic factors

Who is most affected

Adults with flatfoot posture, people in standing occupations, and runners with high weekly load.

Typical symptoms

  • Ankle and plantar foot burning, tingling, or numbness on the inside
  • Worse with standing or walking, sometimes night pain
  • Tinel’s sign (pain with tapping) along the inner ankle

When to seek care

If numbness or weakness develops, or if pain persists beyond two weeks despite relative rest.

How we diagnose

Clinical testing and nerve provocation.

Nerve conduction studies and ultrasound help confirm entrapment and localise the site.

Management

Non-surgical management often decreases and resolves symptoms. A variety of treatment options, frequently used in combination, are available to treat tarsal tunnel syndrome. These include:

  • Physical therapy: Laser therapy, exercises, and other physical therapy modalities may be prescribed to reduce symptoms.
  • Orthoses to reduce pronation and unload the tunnel
  • Neural mobilisation and calf mobility
  • Activity modification and footwear change
  • Over-the-counter medications such as analgesics and NSAIDs
  • Bracing: Patients with flatfoot or those with severe symptoms and nerve damage may be fitted with a brace to reduce the amount of pressure on the foot.
  • Injection therapy: Injections of a local anaesthetic provide pain relief, and an injected corticosteroid may be useful in treating the inflammation.
  • Surgical decompression for confirmed entrapment with neurological deficit

Rehabilitation milestones

Phase 1, weeks 0–4: pain control, orthoses, neural sliders, deload walking plan.

Phase 2, weeks 4–8: foot intrinsic and calf strength, endurance walking.

Phase 3, weeks 8–12: hills and longer walks, work-based modifications.

Phase 4, weeks 12–16: return to sport tasks as symptoms permit.

Readiness to progress

  • Reduced paraesthesia during and after walking
  • Strength and endurance targets met without symptom flare
  • Functional tasks completed without night pain

Prevention

  • Support foot posture
  • Avoid prolonged standing without breaks
  • Maintain calf flexibility

Australia snapshot

  • Uncommon in general practice, but more likely with flatfoot posture and diabetes
  • Surgical series show good outcomes when a clear entrapment is identified and conservative care has not helped
  • Standing occupations and runners make up the majority of presentations

Latest insights

Conservative care comes first.

Orthoses and neural mobilisation reduce symptoms for many patients.

Operative release is best reserved for clear structural compression.

Frequently Asked Questions

Timeframes depend on the grade and your starting capacity. Mild injuries often settle within weeks when loading is matched to tolerance. Moderate injuries take longer to recover from, as strength and control are rebuilt. Severe injuries or those with instability need a longer block and closer supervision. Progress is criteria-based.

Yes, if pain during activity stays at or below 3 out of 10 and does not worsen the next morning. Reduce volume and intensity, maintain a tidy technique, and avoid movements that exacerbate symptoms.

Imaging helps when red flags are present, progress stalls after two weeks, or instability or a tear is suspected. Your clinician will advise on whether an X-ray, ultrasound, or MRI is most suitable.

Use a brace or tape during the early return or on uneven ground. Remove it for controlled strength and balance work so that muscles can relearn their job.

Ice helps early when swelling and pain dominate. Heat helps later when stiffness is the main issue.

When next‑morning pain is 2 out of 10 or less, strength is within 90% of the other side, and you pass the functional test for this condition, such as single‑leg hops, figure‑of‑eight runs, or step‑downs.

Cut the next session’s volume by 20 to 30 per cent, keep strength work, and retest the following day. Progress again when baseline settles.

They can unload sensitive tissue early. Keep them while strength and control improve, then review fit and need.

Sometimes surgery is the best option for treating tarsal tunnel syndrome. The foot and ankle surgeon will determine if surgery is necessary and will select the appropriate procedure or procedures based on the cause of the condition.