Tarsal tunnel syndrome is compression of the tibial nerve as it passes through a narrow space on the inside of the ankle called the tarsal tunnel. It's the foot's equivalent of carpal tunnel syndrome, and it's commonly mistaken for plantar fasciitis or general foot pain.
Symptoms
- Burning, tingling, or numbness on the sole of the foot
- Pain that may radiate into the heel, arch, or toes
- Symptoms often worse at night or after prolonged standing
- Sometimes shooting pain with pressure over the inside of the ankle (Tinel's sign)
- Symptoms usually don't follow a mechanical foot-loading pattern
How it differs from plantar fasciitis
Plantar fasciitis is worst with the first steps in the morning and eases with movement. Tarsal tunnel symptoms are neurological — burning, tingling, sometimes worse at night. Plantar fasciitis is mechanical pain; tarsal tunnel is nerve pain.
Common causes
- Space-occupying lesions in the tarsal tunnel (ganglion cysts, varicose veins, bony spurs)
- Prior ankle injuries with scarring
- Overpronation stretching the nerve
- Systemic conditions (diabetes, rheumatoid arthritis)
- Direct trauma to the inside of the ankle
Diagnosis
Clinical exam with Tinel's sign, careful ruling-out of other causes of foot pain, and often nerve conduction studies. MRI may identify space-occupying lesions if suspected.
Treatment
Address underlying mechanics — custom orthotics for overpronation, footwear assessment.
Manual therapy — soft tissue release around the tarsal tunnel, joint mobilization for the ankle and foot.
Nerve gliding drills — specific exercises that mobilize the tibial nerve without irritating it.
Modality support — laser therapy for nerve pain, TECAR for deep tissue mobility.
Activity modification — reducing sustained loading positions that provoke symptoms.
Systemic management — coordinate with your physician on any underlying medical contributors.
When to consider referral
Persistent symptoms unresponsive to 3-6 months of good conservative care, especially with a clear space-occupying lesion, may benefit from surgical decompression. This is a decision made with an orthopedic or podiatric surgeon.
If your foot pain has nerve-like qualities and hasn't responded to plantar fascia treatment, come in for a proper differential assessment.