Tarsal tunnel syndrome (TTS) occurs when the tibial nerve — which runs through a narrow passage called the tarsal tunnel on the inner side of the ankle — becomes compressed or pinched. That compression can cause burning, tingling, shooting pain, or numbness anywhere from the ankle down into the arch and toes. It's often mistaken for other causes of foot pain, so recognizing the pattern of nerve-type symptoms is the first step toward the right treatment.
The tarsal tunnel is a narrow, protected space formed by bone and a ligament along the inside of the ankle. The tibial nerve, along with blood vessels and tendons, passes through this tunnel on its way into the foot. When something inside or around the tunnel puts sustained pressure on the nerve, it can become irritated or damaged — much like carpal tunnel syndrome, but in the ankle instead of the wrist.
What are the symptoms of tarsal tunnel syndrome?
Because TTS is a nerve condition, its symptoms feel different from typical joint or muscle pain. Common signs include:
- Burning, tingling, or "pins and needles" sensations along the inner ankle, arch, or toes
- Shooting or electric-feeling pain
- Numbness or reduced sensation in the sole of the foot
- Symptoms that worsen with standing, walking, or exercise
- Pain that can radiate up into the calf
Symptoms often start subtly and gradually worsen, which is why many people live with TTS for a while before seeking care.
What causes tarsal tunnel syndrome?
Anything that adds pressure inside or around the tarsal tunnel can compress the tibial nerve. Common causes include:
- Flat feet, which can stretch and place tension on the tibial nerve
- Benign bone growths or cysts near the tarsal tunnel
- Swelling from arthritis
- Varicose veins near the tibial nerve
- Tumors or lipomas pressing on the nerve
- Swelling following an ankle injury or sprain
- Diabetes, which can contribute to nerve changes
- Overuse from running, standing for long periods, or extensive walking
Because ankle injuries and swelling are a common trigger, TTS sometimes develops after an ankle sprain that didn't fully resolve — another reason it's worth having any injury with lingering symptoms checked.
How is tarsal tunnel syndrome diagnosed?
Diagnosis starts with a physical exam, including the Tinel test, where gently tapping over the tarsal tunnel can reproduce tingling or shooting pain if the nerve is compressed. Depending on the exam findings, your podiatrist may also order additional testing such as electromyography (EMG), nerve conduction velocity testing, MRI, or X-rays to identify what's compressing the nerve and rule out other causes.
How is tarsal tunnel syndrome treated?
Treatment usually starts conservatively and escalates only if needed:
- Rest and activity modification to reduce pressure on the nerve
- RICE (rest, ice, compression, elevation) for associated swelling
- NSAIDs to reduce inflammation and pain
- Immobilization, such as a brace or boot, in more irritated cases
- Injection therapy to reduce localized inflammation
- Orthotic devices to correct foot mechanics that stress the nerve — see our custom orthotics options
- Physical therapy and targeted exercises to improve mobility and reduce nerve tension
When TTS is caused by a structural issue such as a cyst, bone growth, or tumor pressing on the nerve, addressing that underlying cause is often part of the treatment plan. Most cases improve with conservative, nonsurgical care, especially when treatment starts early.
When should I see a podiatrist?
See a podiatrist if you notice burning, tingling, numbness, or shooting pain along the inside of your ankle or foot, especially if it worsens with activity or doesn't improve with rest. Because tibial nerve compression can worsen over time and, in longer-standing cases, lead to lasting nerve damage, earlier evaluation gives you more treatment options and a better chance at full recovery. You can request an appointment at either of our Northern Utah offices.
Medically reviewed by the physicians at Wasatch Foot & Ankle Institute. Our board-certified, fellowship-trained podiatrists provide foot and ankle care in Farmington and South Ogden, Utah. This article is for general education and is not a substitute for an in-person evaluation.