Conditions
Tarsal Tunnel Syndrome
Reviewed by Anureet Selach, Podiatrist · Australian Podiatry Association · Registered with AHPRA
Last updated
Burning, tingling or shooting pain on the inside of the ankle, spreading into the arch, the heel or the toes. Numbness, or pins and needles. Often worse at night.
That’s tarsal tunnel syndrome — compression of the posterior tibial nerve where it passes through a narrow space on the inside of the ankle.
Why it matters that it’s a nerve
Most foot pain is mechanical: tissue is being overloaded and it hurts where the load is. Nerve pain behaves differently. It burns, it tingles, it goes numb, it travels along the nerve’s distribution rather than staying where the problem is, and it often intensifies at rest.
That difference is what separates this from plantar fasciitis, which it’s frequently mistaken for, and it’s why the treatment is different.
Symptoms
- Burning or tingling along the inner ankle or the sole
- Pain radiating into the toes
- Numbness, or a pins-and-needles sensation
- Electric or shooting pain
- Often worse at night, or after long periods on your feet
- Sometimes weakness in the foot
What causes the compression
Anything that narrows the tunnel or raises the pressure inside it:
- Ankle injury or trauma, including a previous sprain
- Repetitive stress from high-impact sport
- Arthritis, or bone spurs
- Soft tissue masses — ganglion cysts, lipomas
- Marked flat foot, which changes the tension on the nerve
- Swelling from systemic causes, including pregnancy and diabetes
Some of those are structural and some are biomechanical, which is why the assessment matters before the treatment.
Assessment
Your podiatrist will take the history — the character and the distribution of the symptoms do most of the diagnostic work — and examine the foot and ankle. That includes tapping over the nerve to see whether it reproduces the tingling, and assessing foot posture and mechanics.
Imaging may be arranged to look for a space-occupying cause inside the tunnel. Nerve conduction studies can confirm the compression where the picture is unclear or surgery is being considered.
Treatment
Conservative management is usually the starting point and often the finishing point too, particularly when it’s caught early:
- Orthotics to control foot position and reduce tension on the nerve, especially where a flat foot is involved
- Footwear with adequate support and no pressure over the inner ankle
- Activity modification while the irritation settles
- Hands-on treatment for surrounding soft tissue restriction
- Strengthening through the foot and lower limb
Where conservative care doesn’t resolve it, or where imaging finds something structural inside the tunnel, a surgical opinion is the next step and your podiatrist will arrange the referral.
Don’t sit on this one. A nerve compressed for a long period can be permanently affected, and long-standing numbness is less likely to recover fully than recent numbness.
Frequently asked questions
How is this different from plantar fasciitis?
Plantar fasciitis is a mechanical pain — sharp, in the heel, worst on the first steps of the day. Tarsal tunnel is nerve pain — burning, tingling, numbness or electric sensations, often radiating from the inner ankle into the arch and toes, and frequently worse at night. Nerve symptoms are the distinguishing feature, and the two can occur together.
Why is it worse at night?
Nerve compression symptoms commonly are. Without the distraction of activity, and with the foot in a sustained position, the irritation becomes more noticeable. It's a characteristic enough pattern to be diagnostically useful.
Do I need a scan?
Sometimes. Imaging is used to look for a space-occupying cause — a ganglion cyst, a lipoma, a bone spur — inside the tunnel, and nerve conduction studies can confirm the compression. Not every case needs either.
Can it be treated without surgery?
Frequently, yes, particularly when it's caught before the compression has been present a long time. Offloading, orthotics, footwear, activity change and addressing the mechanics that are narrowing the tunnel all help. Surgery is considered where conservative treatment fails or where something structural needs removing.
Why does early treatment matter?
Because a nerve under sustained compression can be damaged, and numbness or weakness that has been present a long time is less likely to recover fully. It's the reason not to wait this one out.
Ready to book?
Appointments Monday to Saturday, with confirmation by SMS.