Tarsal Tunnel Syndrome

Do you feel burning under your foot? Numbness extending up towards your ankle? That tingling sensation that appears when you walk for too long? These symptoms may indicate Tarsal Tunnel Syndrome.

As physiotherapists, we regularly evaluate and treat this condition. Tarsal Tunnel Syndrome is a compression of the tibial nerve inside the ankle. It causes pain, burning, and numbness under the foot. Physiotherapy effectively treats this condition without surgery in most cases.

• Conservative treatment works: 60 to 90% of cases respond well to physiotherapy.¹
• Trauma is a risk factor: 43% of affected individuals have had a previous ankle injury.²
• Surgery is rarely necessary: It is reserved for cases that do not respond to treatment.
• Early intervention matters: The sooner treatment begins, the better the results.

This guide explains this condition and how to treat it effectively. For an overview of ankle pain, consult our complete guide.

What is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is an irritation or compression of the tibial nerve within the tarsal tunnel, located on the inside of the ankle. It's similar to carpal tunnel syndrome, but in the ankle instead of the wrist.

You might be familiar with carpal tunnel in the wrist. The tarsal tunnel works similarly, but in the ankle.

The tarsal tunnel is a passageway located under the bony bump on the inside of your ankle (the medial malleolus). This tunnel is formed by the ankle bones and a ligament that acts like a roof.

When the space in this tunnel becomes too narrow, the tibial nerve gets compressed. This compression causes the nerve symptoms you experience.

Let's now look at the role of this important nerve.

What is the tibial nerve and what is its role?

The tibial nerve is one of the main nerves in the foot. It starts at the knee, goes down into the calf, and passes through the tarsal tunnel. It's responsible for 90% of the sensation in the sole of the foot and supplies the muscles that bend the toes.³

Think of nerves as electrical cables that transmit signals. The tibial nerve carries two types of signals:

• Sensation in almost the entire sole of the foot
• Sensations of touch, temperature, pressure

• Commands to the calf muscles
• Commands to the muscles that bend your toes

When this nerve is compressed, the electrical signals don't pass through properly. This is what causes abnormal sensations like burning, numbness, and tingling.

Let's now look at what can cause irritation to this nerve.

What are the causes of tarsal tunnel syndrome?

The syndrome is caused by a combination of compression and stretching of the tibial nerve. This reduces blood flow to the nerve. Up to 43% of affected individuals have a history of ankle trauma.²

The exact cause varies from person to person. Several factors can contribute:

How do you know if you have this syndrome? Here are the symptoms to recognize.

What are the symptoms of Tarsal Tunnel Syndrome?

The main symptoms are pain on the inside of the ankle, below the malleolus. The pain can spread towards the arch of the foot or the entire sole. People often feel burning, numbness, or tingling in the foot and toes.

Don't confuse this with plantar fasciitis, which causes heel pain rather than pain on the inside of the ankle.

If these symptoms sound familiar, let's see how the diagnosis is made.

How is Tarsal Tunnel Syndrome diagnosed?

Diagnosis is made based on the symptom history and a clinical examination. An EMG can be helpful but isn't always necessary. The vast majority of cases are treated effectively without this test.³

Your healthcare professional will:

1. Asking you questions about your symptoms: location, onset, what worsens or relieves them
2. Examining your ankle and foot: mobility, strength, sensation
3. Performing specific tests: such as the Tinel's test (tapping on the tunnel to see if it reproduces your symptoms)

EMG measures electrical activity in your nerves and muscles. It can confirm nerve damage, but:

• It is not always necessary to start treatment
• Results can be falsely negative in early stages
• Most cases of tarsal tunnel syndrome are treated without this examination

Now that you know what it is, let's see when to consult a professional.

When should you consult a physiotherapist?

Consult if you have pain, burning, or numbness in your ankle or foot. You don't need to see a doctor beforehand. If your condition requires medical advice, your physiotherapist will guide you.

• Persistent pain on the inside of the ankle
• Burning or numbness under the foot
• Symptoms that increase with activity
• Tingling in the toes

The sooner treatment begins, the better the results. Don't wait for symptoms to become chronic.

Let's see what physiotherapy can do for you.

What treatments does physiotherapy offer?

Your physiotherapist will assess your joint mobility, nerve gliding, movement quality, and strength. Treatment includes mobilizations, stabilization exercises, and rehabilitation to optimize healing.

• Mobility of your ankle and foot
• Nerve gliding test
• Assessment of your movement quality
• Measurement of your strength and stability

Treatment is personalized to your needs. Every person is different, and the causes can vary.

Between your sessions, here's what you can do at home.

What to do at home?

Temporarily reduce activities that cause too much pain and gradually reintroduce them. Opt for low-impact activities like swimming or cycling. Take frequent breaks if pain increases with prolonged standing.

Finally, let's talk about healing time.

How long does healing take?

Healing time varies depending on the severity and duration of symptoms. With physiotherapy treatment, most people see significant improvement within 6 to 12 weeks. Early treatment leads to better results.

• How long you have had the symptoms
• The severity of nerve compression
• Your ability to follow recommendations
• The underlying cause of the problem

• Conservative treatment (physiotherapy) is effective in 60 to 90% of cases¹
• Surgery is rarely necessary
• Most people return to their normal activities

Key points to remember

Tarsal tunnel syndrome is a compression of the tibial nerve at the ankle, causing pain, burning, and numbness. This condition is effectively treated with physiotherapy in most cases.

• Symptoms are caused by nerve compression, not by wear and tear
• Conservative treatment is effective in 60 to 90% of cases
• Early treatment yields better results
• Surgery is rarely necessary

If you have symptoms of tarsal tunnel syndrome, don't wait. Consult a physiotherapist for a complete evaluation and a personalized treatment plan. You do not need a medical prescription.

References

1. Ahmad M, Tsang K, Mackenney PJ, Adedapo AO. Tarsal tunnel syndrome: A literature review. Foot Ankle Surg. 2012;18(3):149-152.
2. Cimino WR. Tarsal tunnel syndrome: review of the literature. Foot Ankle. 1990;11(1):47-52.
3. Kiel J, Kaiser K. Tarsal Tunnel Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023.
4. Lau JT, Daniels TR. Tarsal tunnel syndrome: a review of the literature. Foot Ankle Int. 1999;20(3):201-209.
5. McSweeney SC, Cichero M. Tarsal tunnel syndrome-A narrative literature review. Foot (Edinb). 2015;25(4):244-250.