What Is Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome is compression of the tibial nerve where it passes through a narrow channel on the inside of the ankle, beneath a band of tissue called the flexor retinaculum. Because the problem is a nerve rather than a joint or tendon, the symptoms are burning, tingling or numbness rather than ordinary mechanical pain.
Why it is often mistaken for something else
Nerve pain in the sole is frequently attributed to plantar fasciitis, because both cause pain underfoot. The distinguishing features are the burning or electrical quality of the pain, numbness or pins and needles, and symptoms that are often worse at night or after standing rather than sharpest on the first steps of the morning. Nerve compression higher up, in the lower back, can also refer pain into the same area, which is why the assessment looks beyond the ankle.
What Causes Tarsal Tunnel Syndrome?
Anything that reduces the space inside the tunnel, or increases the tension on the nerve running through it, can produce the symptoms. Often more than one factor is involved, and in some cases no single cause is found.
- A flat foot or a foot that rolls inward, which stretches the nerve as the arch collapses.
- Swelling in the ankle after a sprain or fracture.
- A space-occupying lesion inside the tunnel, such as a ganglion, a varicose vein or a swollen tendon sheath.
- Systemic conditions that cause swelling or affect the nerves, including diabetes and inflammatory arthritis.
- Footwear or bracing that presses directly on the inside of the ankle.
Symptoms to Look Out For
Symptoms follow the nerve, so they run along the inside of the ankle and into the sole, and sometimes into the toes.
- Burning, tingling or an electrical sensation on the inside of the ankle or in the sole.
- Numbness in part of the sole or the toes.
- Symptoms that worsen with prolonged standing or walking.
- Symptoms that are worse at night, or that wake you.
- A sensation reproduced by tapping or pressing on the inside of the ankle.
How Is Tarsal Tunnel Syndrome Diagnosed?
Diagnosis begins with the history and a careful examination: where exactly the symptoms are felt, whether tapping over the nerve reproduces them, how the foot loads when you stand and walk, and whether sensation in the sole has changed.
Because other conditions produce similar symptoms, confirming the diagnosis may involve imaging to look for a space-occupying lesion, or nerve conduction studies, which are arranged rather than performed in the clinic. Your podiatrist explains which, if any, is worth doing in your case.
Conservative Treatment Options
Conservative treatment aims to take tension and pressure off the nerve, which usually means addressing the mechanics of the foot rather than treating the site of the pain.
- Custom orthoses to support the arch and reduce the inward roll that stretches the nerve.
- Footwear changes, including avoiding anything that presses on the inside of the ankle.
- Reducing the activities that reliably bring the symptoms on, while the nerve settles.
- Managing swelling where swelling is part of the problem.
- Addressing any underlying condition, in conjunction with your GP.
Often symptoms associated with biomechanical malalignment are treated with the use of custom foot orthotics. This device can help improve and reduce load on painful structures.
When Symptoms Persist
Where symptoms continue despite conservative treatment, or where a space-occupying lesion is compressing the nerve, surgical release of the tarsal tunnel is the option, and a lesion inside the tunnel may need to be removed. Manly Foot Clinic has a surgical podiatrist on site, so a surgical opinion is available in the same clinic rather than through a separate referral.
Manly Foot Clinic has not published how often surgery is needed for tarsal tunnel syndrome, any success rate for the operation, or a recovery timeline, so this page states none of them. Those are questions for your consultation.
Tarsal Tunnel Syndrome FAQs
Both cause pain underfoot. Tarsal tunnel symptoms are burning, tingling or numb rather than sharp, often run along the inside of the ankle into the sole, and are frequently worse at night or after standing, rather than sharpest on the first steps of the morning.
Nerve symptoms commonly become more noticeable at rest, when there is nothing else competing for attention and the position of the ankle may increase tension on the nerve. It is a characteristic feature rather than a sign the problem is worsening.
Not always. Diagnosis begins with history and examination. Imaging to look for a space-occupying lesion, or nerve conduction studies, may be arranged where they would change the plan. Your podiatrist explains which, if any, is worth doing in your case.
Yes, when they’re the right fit for the problem. Custom orthoses are prescribed after a biomechanical assessment and made from a scan of your feet. They can help redistribute load away from painful areas and improve how your feet and legs work together when you walk or run. Orthoses are usually one part of a plan that may also include footwear advice, stretching and strengthening.
No, you can book directly without a referral. If you’d like, we’ll send a short report to your GP after your appointment so your foot care stays part of your overall health record. If your appointment is through a Medicare care plan, DVA or another funded program, you will need a referral, so check with us when you book.
Serving Manly and the Northern Beaches.
Manly Foot Clinic is at Shop 3/3 Corrie Rd, North Manly, NSW 2100, and treats tarsal tunnel syndrome for patients from Manly, Dee Why, Brookvale, Freshwater and Balgowlah. The clinic is open Monday to Friday from 8:30am to 5:30pm and Saturday from 8:00am to 2:00pm.