Tarsal Tunnel Syndrome

Article by
John Miller,
Shane Armfield

Common causes

Tarsal tunnel syndrome may develop after:

• ankle sprains or fractures (swelling and scar tissue)
• repetitive loading (long walks, running, jumping sports)
• flat feet or a collapsing arch (which can increase tunnel tension)
• tendon irritation near the tunnel (for example, tibialis posterior tendinopathy)
• systemic health factors (for example, diabetes or inflammatory arthritis)

Who commonly develops tarsal tunnel syndrome?

Tarsal tunnel syndrome often affects adults aged 30–60. It is more common in people with flat feet or a collapsing arch, those who spend long hours standing or walking, and anyone with a history of ankle injury or surgery. Runners and active adults may notice symptoms during or after training, while people with diabetes or inflammatory arthritis may experience nerve sensitivity with lower activity levels.

Symptoms

Pain is the most common symptom. It often feels like burning or “electric” discomfort along the inner ankle and into the sole of the foot. Other symptoms may include:

• tingling or pins and needles in the arch, heel, or toes
• worse symptoms after standing or walking for long periods
• night discomfort or throbbing after activity
• reduced toe strength or cramping in the foot muscles

People also ask: is it the same as a pinched nerve?

Tarsal tunnel syndrome is a type of nerve compression in the foot and ankle region. However, “pinched nerve” can also describe nerve irritation in the back, hip, or leg that refers symptoms into the foot. If your symptoms travel above the ankle or include back or leg pain, read pinched nerve and discuss your pattern with a physiotherapist.

Diagnosis

A physiotherapist or doctor can assess your symptoms, foot posture, and ankle movement. They may also test nerve sensitivity around the tunnel and check for other causes of inner-ankle or sole pain.

Sometimes, imaging or nerve tests help when symptoms persist or the diagnosis remains unclear. For a plain-language overview of diagnosis and management, see the NCBI resource on tarsal tunnel syndrome.

Physiotherapy treatment options

Treatment aims to reduce nerve irritation, calm pain, and restore confident walking and sport. Your physiotherapist may recommend a mix of the following:

• load management (adjusting walking, running, or standing time while symptoms settle)
• footwear advice and, if needed, short-term support strategies
• soft tissue treatment to reduce sensitivity in the calf and foot
• graded strengthening for the foot and lower leg
• nerve-friendly mobility drills (often called nerve glides)
• foot posture retraining, such as Active Foot Posture Correction Exercises

Other management options

Some people also use:

• orthoses or arch supports (often short-term, matched to your foot posture)
• anti-inflammatory strategies advised by your GP or pharmacist when appropriate
• guided return-to-run planning if running triggers symptoms

In more persistent cases, a doctor may discuss injection options or a surgical opinion. Surgery is usually considered when symptoms remain stubborn despite a structured period of conservative care, or when a clear structural cause needs release.

Prevention

Prevention often focuses on consistent loading and foot control:

• build training volume gradually (avoid sudden spikes)
• use supportive footwear matched to your activity
• maintain calf, ankle, and foot strength
• address recurring ankle swelling or instability early

What to do next

If you have inner ankle burning, tingling in the sole, or night pain that keeps returning, book a physiotherapy assessment. A clear diagnosis matters because several conditions can mimic each other, including plantar fasciitis, metatarsalgia, and Morton’s neuroma. Your physio can then map a plan that suits your symptoms, sport, and work demands.

Related articles

1. Foot Posture Exercises – Exercises that can improve foot control and reduce overload.
2. Pinched Nerve – A broader guide to nerve compression symptoms and management.
3. Foot Pain – Common causes of foot pain and when to seek help.
4. Plantar Fasciitis – Heel and arch pain that can feel similar.
5. Pes Planus – Flat Feet – How arch posture can influence foot and ankle symptoms.
6. Metatarsalgia – Forefoot pain causes and treatment.
7. Morton’s Neuroma – Nerve-related forefoot pain and numbness.
8. Tibialis Posterior Tendinopathy – Inner-ankle tendon pain that may co-exist with nerve irritation.

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