How effective is custom orthotics for tarsal tunnel syndrome?

Tarsal tunnel syndrome involves irritation or compression of the tibial nerve as it passes behind the inner ankle. Symptoms may include burning, tingling, altered sensation or pain in the sole and toes. An orthotic can support the foot and alter movement that increases tension or pressure along this pathway. It will not address every cause, such as a space-occupying problem or another nerve condition, so the design should follow an examination rather than a generic prescription.

Wear the device in roomy, supportive footwear and increase use only as advised. Pay attention to whether tingling, burning and altered sensation change during walking, after activity or at night. The insert should not create a hard pressure point behind the ankle or along the arch. If symptoms become more intense, spread, or are joined by weakness, remove the device and arrange prompt clinical review.

Arrange an assessment for persistent burning, tingling, numbness or pain around the ankle and sole, especially when symptoms disturb sleep or walking. Seek prompt attention for new weakness, difficulty lifting or controlling the foot, rapidly increasing numbness, severe swelling, or symptoms after significant trauma. Nerve symptoms should not be explained away as a footwear problem without examination.

What supports the diagnosis of tarsal tunnel syndrome, and what other nerve sources should be checked? Which foot movement is this orthotic intended to change? How long should I trial it before review? What symptom changes require stopping it, and do I need tests or another treatment?