Overview
Tarsal tunnel syndrome occurs when the tibial nerve becomes compressed as it passes behind the inner ankle bone, through a narrow passage called the tarsal tunnel, on its way into the sole of the foot.
Anything that narrows this tunnel — swelling, a cyst, varicose veins, flat feet that stretch the nerve, or a poorly healed ankle fracture — can irritate the nerve and produce symptoms in the sole of the foot.
Common Symptoms
- Burning, tingling, "pins and needles" or numbness in the sole of the foot
- Symptoms that build with standing or walking and ease with rest
- Discomfort behind or below the inner ankle bone
- Symptoms that can radiate into the toes or up toward the calf
- Occasionally a positive response to tapping over the inner ankle (a Tinel-like sign)
Plantar fasciitis and other causes of heel or arch pain can feel similar, so location and the presence of true numbness or tingling — rather than a dull ache alone — are useful clues that the nerve is involved.
Practical Changes
Mild cases may respond to reducing the specific standing or walking dose that flares symptoms, supportive footwear, and addressing significant flat-foot posture that stretches the nerve. Swelling-reducing strategies (elevation, activity modification) can help when the tunnel is narrowed by inflammation rather than a structural mass.
Persistent or progressive symptoms are usually assessed with a clinical exam and sometimes nerve-conduction studies or imaging to look for a structural cause within the tunnel.
When to Get It Assessed
Arrange assessment for numbness or tingling that persists beyond a few weeks, symptoms that progressively worsen, weakness of the small foot muscles, or symptoms following an ankle fracture or significant sprain.
References
- StatPearls. "Tarsal Tunnel Syndrome." https://www.ncbi.nlm.nih.gov/books/NBK513274/
- AAOS OrthoInfo. "Tarsal Tunnel Syndrome." https://orthoinfo.aaos.org/en/diseases--conditions/tarsal-tunnel-syndrome/