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What is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve. The tibial nerve branches off of the sciatic nerve and runs into the foot. It passes through the tarsal tunnel, which is a narrow passageway on the inside of the ankle next to the ankle bones.

Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.


Tarsal tunnel syndrome is caused by anything that produces compression on the posterior tibial nerve, such as:

  • Flat Feet: A person with flat feet is at risk for developing tarsal tunnel syndrome, because the outward tilting of the heel that occurs with fallen arches can produce strain and compression on the nerve.
  • Bony growths in the tarsal tunnel: An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve. Some examples include a varicose vein, ganglion cyst, swollen tendon or arthritic bone spur.
  • Injury: an injury such as an ankle sprain may produce inflammation and swelling in or near the tarsal tunnel, resulting in compression of the nerve.
  • Systemic diseases: Conditions such as diabetes or arthritis can cause swelling, thus compressing the nerve.


Patients with tarsal tunnel syndrome experience one or more of the following symptoms:

  • Pain, including sharp, shooting pain
  • Tingling, or an electric shock or burning sensation
  • Numbness, pins and needles

Symptoms are typically felt on the inside of the ankle and/or on the bottom of the foot. In some people, a symptom may be isolated and occur in just one spot. In others, it may extend to the heel, arch, toes and even the calf. Sometimes the symptoms of the syndrome appear suddenly.  They are often brought on or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising or beginning a new exercise program.

Treatment of Tarsal Tunnel Syndrome

Nonsurgical Treatment

Treating tarsal tunnel syndrome depends on symptoms and underlying cause of pain. Nonsurgical treatments include:

  • Rest: Staying off the foot prevents further injury and encourages healing.
  • Ice: Apply an ice pack to the affected area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
  • Anti-inflammatory medications: Nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen can reduce inflammation, which may alleviate compression of the tibial nerve
  • Injections: Steroid injections may be applied to the affected area to reduce swelling
  • Orthotic devices: Custom shoe inserts may be prescribed to help maintain the arch and limit excessive motion that can cause compression of the nerve. Supportive shoes may also be recommended.
  • Bracing/Splinting: 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.

Surgical Treatment

Sometimes surgery is the best option for treating tarsal tunnel syndrome. If surgery is necessary, the best method of surgery is determined after an examination by one of Raleigh Orthopaedic’s foot and ankle specialists based on the cause of the condition.


Schedule an appointment

Your well-being is important to us. Raleigh Orthopaedic is Wake County’s oldest and most experienced orthopedic practice, serving the Triangle and surrounding regions of central North Carolina since 1919. Click the button below or call us to schedule an appointment with one of our orthopedic specialists. If your injury or condition is recent, you can walk right into one of our Raleigh Orthopaedic Urgent Care locations for immediate care. For rehabilitation and physical therapy, no referral is needed to see one of our physical therapists.

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