Tarsal Tunnel Syndrome

A burning sensation under the foot, numbness, or tingling while walking may be signs of tarsal tunnel syndrome. These symptoms can also have other causes; an evaluation can help distinguish between them.

Tarsal tunnel syndrome affects a nerve that runs inside the ankle. Carpal tunnel syndrome affects another nerve, in the wrist. Both conditions involve nerve compression.¹

Physical therapists assess the symptoms and function of the foot. Tarsal tunnel syndrome refers to compression of the tibial nerve or its branches inside the ankle. This compression can cause pain, a burning sensation, or numbness under the foot.² Non-surgical treatments include exercises and adjustments to daily activities. The healthcare professional tailors these treatments to the suspected cause and your response.^{3, 4}

• Non-surgical treatments are often the first line of treatment. Some people see improvement, but the results vary depending on the situation.^{3, 5}
• Tarsal tunnel syndrome may develop after a sprain. A study conducted within a military healthcare system shows that this complication remains rare following a sprain.⁶ Other issues, such as a mass compressing the nerve, may also be involved.²
• Surgery is indicated in certain situations: a surgeon may consider it when symptoms persist despite treatment or when a specific cause of compression requires intervention.^{3, 7}
• An evaluation can help you decide on the right treatment: see a doctor if the pain persists, if your foot feels numb, or if you’re losing strength.⁸

This guide describes the symptoms, diagnosis, and treatments for tarsal tunnel syndrome. Our guide to ankle pain discusses other possible causes.

What is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is caused by compression of the tibial nerve or its branches within a passageway inside the ankle. It is similar to carpal tunnel syndrome in terms of its compression mechanism, but it affects the foot.^{9, 10}

The carpal tunnel is located in the wrist. The tarsal tunnel is located behind and below the bony bump on the inner side of the ankle.⁷

The bones of the ankle and foot form the walls of the tarsal tunnel. A fibrous band, the flexor retinaculum, covers this passageway and holds the structures that pass through it in place.^{2, 11}

A narrow space in the tunnel can compress the tibial nerve. This compression can cause neurological symptoms, but their presence alone is not sufficient to confirm this diagnosis.^{14, 15}

The location of symptoms depends, in particular, on which nerve branches are affected. Their course varies from person to person.^{16, 17, 11}

What is the tibial nerve, and what is its function?

The tibial nerve transmits sensations from the sole of the foot and controls several muscles in the leg and foot. It originates from the sciatic nerve, runs down the calf, and passes through the tarsal tunnel. Its branches control, in particular, the muscles that move the toes.¹³

Nerves transmit signals between the body and the nervous system. The tibial nerve carries sensory information and motor commands:

• The sensory branches transmit sensations from the sole of the foot.
• These branches are involved in the perception of touch, temperature, and pressure.

• The branches that innervate the calf muscles branch off from the nerve before the tarsal tunnel.
• The branches that pass through the tunnel control several small muscles in the foot.

Compression can disrupt nerve function and cause abnormal sensations, such as burning, numbness, or tingling.^{15, 18}

Weakness in the calf, therefore, is not automatically caused by compression in the tarsal tunnel. The healthcare professional also looks for damage located higher up along the nerve’s path.¹³

What are the causes of tarsal tunnel syndrome?

Tarsal tunnel syndrome can result from swelling, a mass, or some other change that compresses the nerve within this passageway. An ankle injury may contribute to the problem. Nerve compression can disrupt blood flow to the nerve; however, this mechanism alone does not explain every case.^{19, 14}

The duration and intensity of compression can affect nerve function. Experiments on the wrist support this general mechanism, but they do not determine the pressure that causes tarsal tunnel syndrome in an individual.^{20, 1}

The clinician looks specifically for an anterior sprain, activities that worsen symptoms, and a local cause of compression. Repeated overexertion and certain foot shapes have been reported in affected individuals, though this does not prove that they account for all cases.^{2, 21}

The evaluation examines the following factors without assuming that any one of them explains your symptoms:

Symptoms help guide the evaluation, but they do not always indicate the cause.

What are the symptoms of tarsal tunnel syndrome?

Tarsal tunnel syndrome can cause pain on the inside of the ankle, as well as a burning sensation, tingling, or numbness under the foot. Symptoms may affect the heel, the arch, or the toes, depending on which nerve branches are affected.^{2, 5}

Plantar fasciitis often causes pain under the heel, especially with the first few steps after resting. Nerve compression can also cause heel pain; therefore, the location alone is not sufficient to distinguish between the two conditions.^{8, 1}

A burning sensation, tingling, or numbness on the sole of the foot is more indicative of nerve damage than of plantar fasciitis alone. An examination is still necessary, as several conditions can present similarly or occur together.¹

The healthcare professional compares your symptoms with several possible causes of foot pain.

How is Tarsal Tunnel Syndrome diagnosed?

A healthcare professional evaluates tarsal tunnel syndrome based onthe patient’shistory of symptoms and an examination of the foot and ankle. No single test can confirm all cases. Diagnostic criteria vary across studies.²³ Nerve conduction studies or imaging tests may be used to supplement the evaluation, depending on the results.^{24, 7}

The professional reviews the following items:

1. He will ask you questions about your symptoms: where they occur, when they started, and what situations make them worse or better.
2. He examines your ankle and foot— checking for range of motion, strength, and sensation.
3. He performs targeted tests: the Tinel test involves tapping along the nerve's path to see if this reproduces your symptoms.

The Tinel test checks for pain or tingling when the healthcare provider taps the nerve behind the inner bump of the ankle. A positive result guides the evaluation but does not confirm the diagnosis on its own.^{1, 23}

Electrodiagnostic testing evaluates the function of nerves and muscles. Nerve conduction studies measure the transmission of signals through the nerves; electromyography, or EMG, measures the electrical activity of muscles. These tests can support the diagnosis of nerve damage.²⁴

• The healthcare professional decides whether these tests would help clarify the diagnosis.
• A normal result does not always rule out tarsal tunnel syndrome.
• An ultrasound or magnetic resonance imaging (MRI) scan can be used to look for a mass or another cause of compression.⁷

A loss of strength or sensation warrants a medical evaluation, even if the pain remains tolerable.⁸

When should I see a physiotherapist for tarsal tunnel syndrome?

You should see a physical therapist if you experience persistent pain, a burning sensation, or numbness in your foot, or if these symptoms limit your activities. New weakness or symptoms that are getting worse also require medical attention.⁸

• The pain on the inside of your ankle persists.
• You feel a burning sensation or numbness on the bottom of your foot.
• Your symptoms worsen during physical activity.
• You're still feeling a tingling sensation in your toes.

Seek medical attention immediately if the pain is severe, if you are unable to walk, or if your foot is deformed. A cracking sound at the time of an injury, or pain that causes dizziness or nausea, also warrants urgent evaluation. If you have diabetes and are experiencing foot pain, seek medical advice.⁸

The professional will determine whether physical therapy is appropriate for your situation or if further evaluation is needed.

What are the physical therapy treatments for tarsal tunnel syndrome?

Physical therapy for tarsal tunnel syndrome may include ankle mobilization, nerve mobilization exercises, strengthening exercises, and movement rehabilitation. The physical therapist selects these interventions based on your specific challenges. Nerve mobilization exercises have been studied as an adjunct to other treatments, with results that vary depending on the measures and studies used.^{26, 27}

A trial involving 28 participants followed for six weeks reported improvements in both groups, with no additional benefit in terms of pain, strength, or mobility from the addition of nerve mobilization. Improvements in certain measures of sensitivity were observed in the group that received this additional treatment.²⁶ Another trial involving 54 participants reported benefits in pain, mobility, and nerve conduction after four weeks, with this addition to the same baseline care in both groups.²⁷ These studies do not allow us to promise the same outcome with any combination of mobilizations andstabilization exercises.

• The physical therapist will assess the range of motion in your ankle and foot.
• He observes your response to movements that stimulate the nerves.
• It analyzes your foot movements during relevant activities.
• It measures your strength and balance.

The physical therapist tailors the program to your goals and your response. He or she assesses your pain, sensitivity, strength, and the activities you are able to do.

Home exercises should be tailored to your symptoms. Report any persistent increase in numbness or new weakness.

What can you do at home to treat tarsal tunnel syndrome?

At home, you can temporarily reduce activities that worsen tarsal tunnel syndrome symptoms, then work with your healthcare provider to gradually resume them. Resuming sports activities may include swimming or cycling if you can tolerate them. The intensity of your activities will depend on how you respond, even when the activity involves minimal impact.²⁸

If the pain persists or worsens, see a doctor to have the situation reevaluated. A loss of sensation or weakness also requires medical attention.⁸

Follow-up visits are used to monitor progress and adjust treatment if symptoms change.

How long does it take to recover from tarsal tunnel syndrome?

Recovery time for tarsal tunnel syndrome varies; there is no specific timeframe that applies to everyone. Studies—mostly surgical in nature and of limited quality—describe possible links to the duration of symptoms, their severity, and the cause of the compression. They do not allow us to predict your personal recovery time.⁴

A physical therapy program can improve symptoms and certain functional abilities. The two trials described above assessed outcomes after four or six weeks; these follow-up periods do not guarantee a cure.^{26, 27}

• The healthcare professional asks how long you've had your symptoms.
• He monitors changes in your sensitivity and strength.
• You discuss together the obstacles that make the program difficult to follow.
• He is looking for a cause of compression that might require further treatment.

Non-surgical treatments can relieve symptoms. If the results are still insufficient, the healthcare professional will reassess the diagnosis and treatment options. Studies do not provide a single success rate that applies to everyone.^{3, 4}

Some people get better without treatment, while others continue to experience symptoms. A small follow-up study of patients describes these two outcomes; it does not allow us to predict which one applies to you.⁵

A surgeon may consider surgery if significant symptoms persist despite appropriate care and the evaluation supports the diagnosis. A mass compressing the nerve or motor impairment may also require a surgical evaluation sooner. The decision depends on the cause, the results of the examination, and the expected benefits and risks.^{3, 4, 7}

What should you know about tarsal tunnel syndrome?

Tarsal tunnel syndrome can cause pain or numbness in the ankle and foot due to compression of the tibial nerve. An evaluation helps distinguish this condition from other causes and determine the appropriate treatment. Physical therapy is one of the options that can improve symptoms.^{15, 26}

• The symptoms of tarsal tunnel syndrome are related to nerve compression; they alone are not sufficient to determine the cause.²
• Non-surgical treatments can help; surgery remains an option in certain situations.^{3, 4}
• Severe pain, an inability to walk, or a new loss of strength requires a medical evaluation.⁸

A physical therapy consultation allows for an assessment of your difficulties and the development of a tailored program. In Quebec, you can see a physical therapist at a private clinic without a doctor’s prescription.²⁵

References

The following references outline the research on tarsal tunnel syndrome and the resources that support the recommendations in this article.

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1. Ferkel E, Davis WH, Ellington JK. Entrapment Neuropathies of the Foot and Ankle. Clin Sports Med. 2015;34(4):791-801. (Back to sections: 1, 2, 3, 4, 5)
2. Fortier LM, Leethy KN, Smith M, McCarron MM, Lee C, Sherman WF, et al. An Update on Posterior Tarsal Tunnel Syndrome. Orthop Rev (Pavia). 2022;14(4):35444. (Back to sections: 1, 2, 3, 4, 5, 6)
3. Vij N, Kaley HN, Robinson CL, Issa PP, Kaye AD, Viswanath O, et al. Clinical Results Following Conservative Management of Tarsal Tunnel Syndrome Compared With Surgical Treatment: A Systematic Review. Orthop Rev (Pavia). 2022;14(3):37539. (Back to sections: 1, 2, 3, 4, 5, 6, 7)
4. Haq II, Banerjee AA, Arshad Z, Iqbal AM, Bhatia M. The management of tarsal tunnel syndrome: A scoping review. J Clin Orthop Trauma. 2024;54:102489. (Back to sections: 1, 2, 3, 4, 5)
5. Mondelli M, Giannini F, Reale F. Clinical and electrophysiological findings and follow-up in tarsal tunnel syndrome. Electroencephalogr Clin Neurophysiol. 1998;109(5):418-25. (Back to sections: 1, 2, 3)
6. Foster KS, Greenlee TA, Young JL, Janney CF, Rhon DI. How Common Is Subsequent Posterior Tibial Tendon Dysfunction or Tarsal Tunnel Syndrome After an Ankle Sprain? J Knee Surg. 2022;35(11):1181-1191. (Back to section: 1)
7. Adler L, Bergman R, Kaiser K. Tarsal Tunnel Syndrome. [Updated May 24, 2026]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026. (Back to sections: 1, 2, 3, 4, 5)
8. nhs.uk. Pain in the bottom of the foot. 2022. (Back to sections: 1, 2, 3, 4, 5, 6, 7)
9. Ahmad M, Tsang K, Mackenney PJ, Adedapo AO. Tarsal tunnel syndrome: A literature review. Foot Ankle Surg. 2012;18(3):149-52. (Back to section: 1)
10. Cimino WR. Tarsal tunnel syndrome: a review of the literature. Foot Ankle. 1990;11(1):47-52. (Back to section: 1)
11. Torres AL, Ferreira MC. Study of the anatomy of the tibial nerve and its branches in the distal medial leg. Acta Ortop Bras. 2012;20(3):157-64. (Back to sections: 1, 2)
12. de Souza Reis Soares O, Duarte ML, Brasseur JL. Tarsal Tunnel Syndrome: An Ultrasound Pictorial Review. J Ultrasound Med. 2022;41(5):1247-1272. (Back to sections: 1, 2, 3, 4, 5)
13. Lew JT, Stearns M. Tibial Neuropathy. StatPearls. 2023. (Back to sections: 1, 2, 3)
14. Jacobson L, Dengler J, Moore AM. Nerve Entrapments. Clin Plast Surg. 2020;47(2):267-278. (Back to sections: 1, 2)
15. Sha I I. Tarsal Tunnel Syndrome—A Comprehensive Review. Iowa Orthop J. 2024;44(2):32–36. (Back to sections: 1, 2, 3)
16. Lau JT, Daniels TR. Tarsal tunnel syndrome: a review of the literature. Foot Ankle Int. 1999;20(3):201-9. (Back to section: 1)
17. McSweeney SC, Cichero M. Tarsal tunnel syndrome—A narrative literature review. Foot (Edinb). 2015;25(4):244-50. (Back to section: 1)
18. Krimmer H. [Pathophysiology of nerve compression]. Langenbecks Arch Chir Suppl Kongressbd. 1998;115:627-9. (Back to section: 1)
19. Mackinnon SE. Pathophysiology of nerve compression. Hand Clin. 2002;18(2):231-41. (Back to section: 1)
20. Szabo RM, Gelberman RH. Peripheral nerve compression: etiology, critical pressure threshold, and clinical assessment. Orthopedics. 1984;7(9):1461-6. (Back to section: 1)
21. Kinoshita M, Okuda R, Yasuda T, Abe M. Tarsal tunnel syndrome in athletes. Am J Sports Med. 2006;34(8):1307-12. (Back to sections: 1, 2)
22. Choo YJ, Park CH, Chang MC. Rearfoot disorders and conservative treatment: a narrative review. Ann Palliat Med. 2020;9(5):3546-3552. (Back to sections: 1, 2)
23. Boers N, Haverkamp M, Eligh AM, Cabezas MC, Coert JH, Rinkel WD. Differences in the Diagnosis of Tarsal Tunnel Syndrome Across the Literature: A Systematic Review and a Call for Standardization. JBJS Rev. 2026;14(2). (Back to sections: 1, 2)
24. Patel AT, Gaines K, Malamut R, Park TA, Toro DR, Holland N, et al. The usefulness of electrodiagnostic techniques in the evaluation of suspected tarsal tunnel syndrome: an evidence-based review. Muscle Nerve. 2005;32(2):236-40. (Back to sections: 1, 2)
25. OPPQ. How does it work? (Back to sections: 1, 2)
26. Kavlak Y, Uygur F. Effects of nerve mobilization exercises as an adjunct to conservative treatment for patients with tarsal tunnel syndrome. J Manipulative Physiol Ther. 2011;34(7):441-8. (Back to sections: 1, 2, 3, 4)
27. El-Nassag BA, Abdelhakiem NM, Abdelhamid AS, El-Marakby RM, Salem S. Short-term effectiveness of the tibial nerve flossing technique in patients with tarsal tunnel syndrome. J Back Musculoskelet Rehabil. 2025;38(6):1446-1457. (Back to sections: 1, 2, 3)
28. Tarsal Tunnel Syndrome. (Back to sections: 1, 2)