Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome

Article by John Miller

Tarsal Tunnel Syndrome

What is Tarsal Tunnel Syndrome?

Tarsal Tunnel Syndrome is a condition of the foot involving compression of the tibial nerve. The tibial nerve extension of the sciatic nerve runs down the back of the thigh. Your tibial branch extends across the inside of the shin and then splits in the foot to supply sensation along the bottom inner foot and movement to the muscles.

Tarsal Tunnel Syndrome entails compression of the end part of the tibial nerve as it travels through the tarsal tunnel. Your tarsal tunnel location is between the Achilles tendon and a bony bump along the inner aspect of the ankle. In this region, the tibial nerve also passes underneath a thick piece of connective tissue (or retinaculum), which can be a source of compression when it becomes too tight.

What Causes Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome can occur as a result of a trauma (i.e. fall or impact). Overuse of the muscles and tendons that supply the muscles which bend the toes can also be a precipitating factor. Hence, tarsal tunnel syndrome can acutely result following a marathon or endurance race (Antoniadis 2008). Complications post-surgery or following an ankle sprain or other lower limb injury, which produces swelling around the ankle, can cause compression of the tibial nerve (Antoniadis 2008). People with diabetes and rheumatoid arthritis are also at increased risk of developing tarsal tunnel syndrome.

Posterior Tarsal Tunnel Syndrome: Diagnosis and Treatment. Antoniadis, G., Schedglmann, K. (2008). Deutsches Arzteblatt International. 105(45): 776-81.

What are the Symptoms of Tarsal Tunnel Syndrome?


tarsal tunnel syndrome

The primary symptom someone with tarsal tunnel syndrome experiences is pain. In particular, burning pain along the inner aspect of the ankle or into the bottom of the foot. The following symptoms may also occur:

  • Tingling or pins and needles along the inner aspect of the ankle and foot
  • Pain with extended periods of walking or standing
  • Burning sensation at night
  • Weakness in the muscles that bend the toes and fan them outwards

How is Tarsal Tunnel Syndrome Diagnosed?

Your physiotherapist or doctor can provisionally diagnose tarsal tunnel syndrome. They will conduct various physical tests to support the diagnosis if suspected through your verbal injury history. In some cases, a nerve conduction study may confirm the diagnosis.

Please consult your physiotherapist or doctor for individual guidance.

Treatment for Tarsal Tunnel Syndrome?


Many patients with tarsal tunnel syndrome start to feel better within a couple of weeks of treatment. The time frame of your recovery will depend on a variety of factors such as age, previous activity level, treatment compliance and the degree/length of your injury.

Your physiotherapy treatment will aim to:

  1. Reduce pain and inflammation.
  2. Provide advice on corrective footwear or footwear accessories if necessary.
  3. Strengthen the muscles around your knee
  4. Strengthen other muscles in your lower limb, including your calves, hip and pelvic muscles
  5. Normalise your muscle lengths
  6. Improve your proprioception, agility and balance
  7. Improve your technique and function (e.g. walking, running, squatting, hopping and landing)
  8. Minimise your chance of re-injury

If you have any questions at any stage of your rehabilitation, please call your physiotherapist.

How to Prevent Tarsal Tunnel Syndrome?

There are a few things you can do to reduce your risk of developing tarsal tunnel syndrome. These include

  • Correct, supportive footwear that is not tight or constrictive
  • Adequately manage foot or ankle swelling following an injury or surgery to the leg. Treatment can include active exercises, massage and compression stockings.
  • Avoid sudden increases in high-impact activities (i.e. running)

Alternative Treatments for Tarsal Tunnel Syndrome

Injections: Injections of a local anaesthetic and corticosteroids into the tarsal tunnel region can sometimes be beneficial in some cases.

Surgery: In cases of severe pain, an operation can be quite useful. The procedure involves decompressing the affected parts of the tibial nerve and potentially its branches in the foot. The post-surgical routine consists of elevating the operated leg and walking with crutches for two weeks (Antoniadis 2008).

For specific advice regarding the best management for your tarsal tunnel syndrome, please consult your trusted physiotherapist.