Tarsal tunnel syndrome is a compression of the posterior tibial nerve as it passes through the tarsal tunnel, a narrow space on the inside of the ankle. It produces nerve-type symptoms — burning, tingling, numbness, or shooting pain — that radiate from the inside of the ankle into the foot. It's often compared to carpal tunnel syndrome in the wrist, since both involve a major nerve being pinched as it passes through a confined space. Left untreated, it can progress to permanent nerve damage, so prompt evaluation matters.
If you've noticed burning, tingling, or an electrical "shock" sensation along the inside of your ankle or the bottom of your foot, it's worth having it checked rather than waiting it out. Our podiatrists in Farmington and South Ogden diagnose and treat nerve compression conditions like tarsal tunnel syndrome regularly. Here's what to know.
What is the tarsal tunnel?
The tarsal tunnel is a narrow space that lies on the inside of the ankle, next to the ankle bones. It is covered by a strong band of tissue called the flexor retinaculum, which protects and forms a "tunnel" around several important structures — arteries, veins, tendons, and the posterior tibial nerve — as they pass from the leg into the foot.
Because this tunnel is narrow and largely rigid, there is very little extra room inside it. Anything that increases pressure within the tunnel or reduces the space available can compress the structures inside, most importantly the posterior tibial nerve.
What is tarsal tunnel syndrome?
Tarsal tunnel syndrome is a compression, or squeezing, of the posterior tibial nerve as it passes through the tarsal tunnel. It is often compared to carpal tunnel syndrome in the wrist, since both conditions involve a major nerve being pinched as it passes through a confined anatomical space. The result is nerve-type symptoms — burning, tingling, numbness, or shooting pain — that radiate from the inside of the ankle into the foot.
What causes tarsal tunnel syndrome?
Tarsal tunnel syndrome develops whenever something increases pressure on the posterior tibial nerve within the tunnel. Common contributing factors include:
- Flat feet, which can cause the heel to tilt outward and place added strain on the nerve — see our flat feet page for more on this connection
- Enlarged structures within the tunnel, such as varicose veins, a ganglion cyst, a swollen tendon, or a bone spur
- Swelling following an ankle injury
- Systemic conditions such as diabetes or arthritis that increase pressure on or around the nerve
In many patients, more than one of these factors is present at once, which is why a full evaluation of foot structure and medical history is an important part of diagnosis.
What are the symptoms of tarsal tunnel syndrome?
Because tarsal tunnel syndrome affects a nerve rather than a bone or ligament, symptoms tend to feel different from typical foot pain. Patients often describe:
- Tingling, burning, or an electrical "shock" sensation
- Numbness along the inside of the ankle or foot
- Shooting pain that radiates into the arch, heel, or toes
- Symptoms that worsen with standing, walking, or activity
Symptoms can affect the bottom of the foot, the heel, the arch, the toes, or the ankle itself, depending on exactly where the nerve is compressed.
How is tarsal tunnel syndrome diagnosed?
Diagnosis begins with a physical examination, including tapping over the nerve to see if it reproduces your symptoms, along with a review of your medical history and any conditions — such as flat feet, diabetes, or arthritis — that could be contributing. Your podiatrist will also assess your foot structure and gait, since mechanical factors like flat feet are a common underlying cause.
Additional testing, such as nerve conduction studies or imaging, may be used in some cases to confirm the diagnosis, pinpoint the location of the compression, and rule out other causes of nerve-type foot symptoms.
How is tarsal tunnel syndrome treated?
Most cases of tarsal tunnel syndrome are treated first with nonsurgical care aimed at reducing pressure on the nerve and calming inflammation. Options include:
- Rest and activity modification to reduce strain on the nerve
- Ice application to reduce local swelling
- NSAIDs to reduce pain and inflammation
- Custom orthotics to correct underlying foot mechanics such as flat feet — see our custom orthotics options
- Physical therapy to support healthy foot and ankle mechanics
- Injection therapy for more focused inflammation and pain relief
If left untreated, tarsal tunnel syndrome can progress and may result in permanent nerve damage, so timely evaluation matters. When nonsurgical measures don't adequately relieve symptoms, or an underlying structural cause such as a cyst or bone spur is identified, surgery to release pressure on the nerve may be recommended.
What does recovery from tarsal tunnel syndrome look like?
Recovery depends heavily on how long the nerve has been compressed and how it responds to treatment. Nerve tissue can be slow to heal, so some patients notice gradual rather than immediate improvement even with the right treatment plan. Addressing the underlying cause — whether that's footwear, foot structure, or a structural mass — is essential to a lasting recovery and to preventing symptoms from returning.
When should you see a podiatrist for these symptoms?
See a podiatrist if you notice burning, tingling, numbness, or shooting pain along the inside of your ankle or foot, especially if it persists or worsens over time. Because untreated tarsal tunnel syndrome can lead to permanent nerve damage, prompt evaluation is important rather than waiting to see if symptoms resolve on their own. When you're ready, you can request an appointment at either of our Northern Utah offices.
Medically reviewed by the physicians at Wasatch Foot & Ankle Institute. Our board-certified, fellowship-trained podiatrists provide foot and ankle care in Farmington and South Ogden, Utah. This article is for general education and is not a substitute for an in-person evaluation.