Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is compression or irritation of the posterior tibial nerve as it passes behind the inner ankle. This nerve carries sensation from parts of the sole and helps control some foot muscles. Pressure in the narrow passage can cause burning, aching or altered sensation that travels into the heel or sole.

Heel pain is a common presentation of tarsal tunnel syndrome, and leg numbness and tingling are also common presentations. Symptoms may affect the inner ankle, heel, arch or sole and can extend into the toes. They may feel worse after standing, walking or other activity, and some people notice increased discomfort at night. Weakness or a feeling of poor balance can occur when nerve compression affects muscle control.

The posterior tibial nerve may be crowded by swelling, a change in foot shape, scar tissue or a space-occupying lump. An ankle injury can inflame nearby tissues, while altered mechanics can increase tension along the nerve. Sometimes no single cause is found. A clinician considers the ankle, foot, nerve pathway and any medical conditions that may affect nerve health.

Symptoms can come and go or remain present during periods of repeated loading. Continuing an aggravating activity may make the area more sensitive, whereas reducing pressure and addressing foot or ankle mechanics may ease symptoms. Persistent compression can lead to ongoing numbness or weakness, so a changing pattern deserves assessment rather than self-treatment alone.

Risk may increase with ankle sprains, swelling, flat-foot mechanics, arthritis, diabetes or activities that repeatedly load the ankle. Tight footwear and prolonged standing can aggravate pressure in the tunnel. These factors do not confirm the condition; they help a clinician decide what to examine and which contributing problem to address.

Assessment usually begins with questions about where symptoms travel, when they appear and whether an injury or health condition preceded them. The clinician checks sensation, muscle strength, reflexes, foot alignment and ankle movement, and may gently tap or press over the nerve. Nerve conduction testing, ultrasound or magnetic resonance imaging may be considered when the diagnosis is uncertain or a structural cause needs investigation.

Treatment is matched to the cause and severity. Rest from a provoking activity, footwear changes and support for foot mechanics may reduce pressure. Custom orthotics can alter how the foot loads the inner ankle, while physiotherapy may address ankle mobility, calf flexibility, strength and movement habits. A cortisone injection may be discussed for selected cases, with the clinician explaining its purpose and limitations. Persistent compression from a structural problem may require specialist review.

Use symptom changes to guide activity: shorter walks, supportive shoes and breaks from standing may be more comfortable than pushing through increasing tingling. Follow a prescribed exercise plan gradually, and record which positions or activities provoke symptoms. New weakness, spreading numbness or difficulty walking should prompt a clinical review.

Untreated or persistent nerve compression may contribute to lasting altered sensation, weakness or changes in walking. These outcomes are not inevitable, but they are reasons to arrange assessment when symptoms persist, progress or interfere with daily movement.

There is no guaranteed way to prevent every case. Wearing comfortable shoes, managing ankle swelling after injury, varying standing tasks and maintaining ankle and calf mobility can reduce repeated pressure. Managing conditions that affect nerves and seeking advice after an ankle injury may also help protect function.

An orthopedist, neurologist or physiotherapist can help assess symptoms around the inner ankle and foot. Bring a list of activities that trigger symptoms, prior ankle injuries, footwear changes and any numbness or weakness you have noticed.