When is custom orthotics recommended for tarsal tunnel syndrome?

Tarsal tunnel syndrome involves irritation or compression of the tibial nerve as it passes through a narrow space near the inner ankle. Burning, tingling, altered sensation or aching can travel into the sole or toes. A custom orthotic may support the arch and change how the foot loads, potentially reducing strain around the tunnel during standing and walking. It cannot identify the cause of nerve compression or replace a neurological examination.

A clinician should assess sensation, muscle strength, ankle movement, foot posture and possible sources of nerve pressure before prescribing an orthotic. Wear shoes with enough room and avoid straps or edges that press against the inner ankle. Follow activity advice and any physiotherapy plan. Stop using the device and request a fit check if tingling, burning, skin irritation or weakness increases.

Seek medical assessment for persistent burning or numbness, symptoms that spread, night discomfort, balance changes or weakness in the foot. Prompt care is needed for rapidly worsening weakness, loss of feeling, severe swelling, a cold or discoloured foot, or difficulty walking. Nerve symptoms deserve evaluation rather than repeated changes of insole.

Ask what may be irritating the nerve, whether an orthotic is suitable for your foot shape, and how its effect will be monitored. Discuss footwear, activity limits, physiotherapy, other treatment options and the warning signs that require an earlier review.