Tarsal Tunnel Syndrome
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Tarsal tunnel syndrome happens when a nerve is squeezed as it passes through a narrow space on the inner side of your ankle. It is less common than other nerve squeezing problems and is often missed, so it is hard to say exactly how common it is. The main symptoms are burning pain, tingling or numbness in the heel, the sole of your foot or the inner ankle. These are often worse after standing or walking, and at night. Treatment without surgery is usually successful, and finding the cause early gives the best chance of protecting the nerve.
What is it?
Tarsal tunnel syndrome is a squeezing of the posterior tibial nerve (a nerve that runs down the back of your leg and into your foot). It happens where the nerve passes through the tarsal tunnel, a narrow space behind the bony bump on the inner side of your ankle. A tough band of tissue (the flexor retinaculum) forms the roof of this tunnel.
After passing through the tunnel, the nerve branches to supply the heel and the sole of your foot. When the nerve is squeezed, these are the areas where you feel it.
The condition is often missed or mistaken for other foot problems, so it is worth getting any burning, tingling or numbness in the sole checked properly.
Who does it affect?
It is less common than other nerve squeezing problems, and no reliable figure is available for how many people have it. Because it is often missed, it is probably more common than it looks.
Anyone can develop it, but some things are linked to it. These include a past ankle injury, foot shape problems, being overweight, and conditions such as diabetes, arthritis, an underactive thyroid and pregnancy. Runners and other athletes may be at higher risk, especially if their feet roll inwards a lot.
These are links, not proven causes. Having one of them doesn't mean you will get tarsal tunnel syndrome.
Signs and symptoms
The typical symptoms are burning pain, tingling and numbness. You usually feel them in the heel, the sole of your foot and the inner ankle, and sometimes in the inner part of the foot and the toes. Some people also notice that the skin on the sole sweats less.
Symptoms are often worse after standing or walking for a long time, and they are often stronger at night. They tend to ease when you rest with your foot raised. The pain can spread into the arch of your foot. If the nerve is badly squeezed, it can travel up the inside of your leg, and sometimes feels like sciatica.
Over time, the small muscles in the foot can become weak or thin. This may not be obvious at first, because other muscles make up for it.
What causes it?
It comes from pressure on the nerve inside the tunnel. In many cases, probably most, no clear cause is found. Less room for the nerve and high pressure in the area are thought to be behind these cases, and certain activities and positions can make it worse.
When a cause is found, it is usually something local. Examples are:
- a lump or cyst
- a bone spur
- an extra (variant) muscle
- swollen veins (varicose veins)
- inflamed tendons
- scarring
- an injury
- an unstable ankle
A nerve tumour can also be the cause, though this is rare. Conditions such as diabetes and rheumatoid arthritis are also linked to it.
A lump or other growth may be the cause, so it is important to have the area properly assessed. Don't assume it is just overuse.
How is it diagnosed?
Your podiatrist will ask where your symptoms are, when they happen, and what makes them better or worse. They will ask whether one foot or both are affected, and about past injuries or surgery, and about other health conditions. They will then examine your foot and ankle.
A common test is called Tinel's sign. Your podiatrist taps over the nerve at your inner ankle to see whether it brings on tingling. It is one part of the assessment, not a test that settles things on its own. No single test confirms tarsal tunnel syndrome, so your podiatrist puts the whole picture together.
Other problems can feel similar, which is why a careful assessment matters:
- Plantar fasciitis (irritation of the thick band under your foot) causes a dull ache in the sole, heel and arch, often worst with your first steps in the morning.
- A pinched nerve in the lower back can cause patchy symptoms in the sole, usually on one side.
- Nerve damage affecting both feet (polyneuropathy) is more likely if both feet are affected.
- Poor circulation can cause an aching arch, heel or calf with walking that eases with rest. Your podiatrist may check the pulses in your foot, and a simple circulation test called the ankle-brachial index can be used.
- Other squeezed nerves in the foot, such as Baxter's nerve or Morton's neuroma, can also feel similar.
If a lump is felt or suspected, you may be sent for a scan. MRI is the most reliable way to look for a lump-like cause. X-ray, ultrasound, CT and a nerve test (electromyography) may also be used to confirm the diagnosis and tell it apart from other conditions.
Treatment
Treatment usually starts with simple care that doesn't involve surgery, and this is usually successful. It isn't yet known which of these simple treatments works best, so your plan may be adjusted as you go.
Looking after it at home
Rest, or change the activities that bring on your symptoms, so the nerve gets a break. Supportive footwear can help.
If you want to try ice, don't use it if you are sensitive to cold, have an open wound, have poor circulation, or can't feel hot and cold normally.
For pain relief, options include paracetamol, anti-inflammatory medicines, medicines for nerve pain, and creams or gels applied to the skin. Ask your GP or pharmacist which are safe for you.
Treatment from your podiatrist
Your podiatrist or physiotherapist may use hands-on treatment such as massage, taping and stretching. They can also teach you exercises, which may include calf stretching, nerve gliding (gentle movements that help the nerve slide more freely) and strengthening for a lower-leg muscle called tibialis posterior.
A small wedge on the inner side of the heel, or a heel seat, can tilt your heel gently and take tension off the nerve. Your podiatrist can tell you whether this or shoe inserts (orthoses) suit you.
Other options
A corticosteroid injection is sometimes discussed. It carries a risk of tearing or rupturing nearby tendons, so it is generally kept as a last resort. More than one injection is generally not recommended, because of the risk to tendons and bone.
Surgery
Surgery to release the pressure on the nerve (decompression) may be offered if simple care hasn't worked, or if a cause such as a lump is found. The surgeon frees the nerve in the tunnel, and sometimes its branches in the foot.
Surgery has risks, including slow wound healing, infection and scarring. Before agreeing to it, ask about the likely benefit, the recovery plan and these risks. Your diagnosis should be confirmed first.
Recovery
How long recovery takes, and how often the problem comes back, isn't clear yet. It is likely to vary from person to person.
What is clear is that acting early matters. If the nerve stays squeezed, delay can increase the chance of lasting nerve damage. Untreated or stubborn tarsal tunnel syndrome can lead to ongoing pain, weakness and wasting of the foot muscles.
A nerve test showing very slow signals through the nerve usually means simple treatment is less likely to work. Tell your practitioner if your symptoms persist, spread or get worse, so your plan can be reviewed.
Preventing it
No proven way to prevent tarsal tunnel syndrome or stop it coming back is available yet. The best step is to get symptoms assessed early and follow the plan from your podiatrist, physiotherapist or doctor.
Ask your practitioner how to reduce the triggers in your own situation, such as how much activity you do and what shoes you wear. If your symptoms return, don't wait: have them reviewed again.
When to see a podiatrist
When to book
Book an appointment with your podiatrist if you have burning, tingling or numbness in your heel, the sole of your foot or your inner ankle, if your symptoms keep coming back or aren't improving with rest and home care, or if you've been told it is plantar fasciitis and treatment hasn't helped.
When to get help sooner
Call your local emergency number if your leg, foot or toes suddenly turn cold and pale or blue, with pain or numbness, or if you suddenly can't move your leg or foot. See your GP soon, and don't wait to see if it settles, if you notice a lump near your inner ankle, weakness or thinning of the muscles in your foot, loss of balance, or a cut or sore on your foot that isn't healing. See your GP soon too if you get aching in your arch, heel or calf when you walk that eases with rest, or if both feet have symptoms. If you have diabetes and notice any new foot symptom, see your GP or podiatrist soon.
Frequently asked questions
Is it like carpal tunnel syndrome?
It is similar in the way it works. Carpal tunnel syndrome squeezes a nerve at the wrist, and tarsal tunnel syndrome squeezes a nerve at the ankle. Tarsal tunnel syndrome is much less common, so it is more often missed.
Does diabetes make it worse?
It can make things harder. If you already have nerve damage from diabetes, the symptoms overlap and tarsal tunnel syndrome is harder to diagnose. It is also linked to a higher risk of foot ulcers. Check your feet often and get any new foot symptom or wound looked at early. The role of surgery is debated for people with diabetes, so ask for specialist advice.
Can I keep running?
It depends on your symptoms, and your podiatrist or physiotherapist can guide how much activity suits you. Burning or tingling in the sole is worth getting assessed rather than simply training through it.