Ankle & foot
Tarsal Tunnel Syndrome
Burning, tingling or numbness into the sole from a squeezed tibial nerve at the inner ankle. Often linked to flat feet, swelling or a past ankle injury.
Common symptoms
- Burning, tingling or pins and needles in the sole, arch, heel or toes
- Numbness in parts of the sole of the foot
- Pain or aching on the inside of the ankle
- Symptoms worse after standing or walking for long periods
- Symptoms that can be troublesome at night
- Tingling into the foot when the inner ankle is tapped
- Relief with rest and taking the shoe off
Overview
The tarsal tunnel is a narrow passage on the inside of the ankle, just behind and below the bony bump of the inner ankle, roofed by a band of tough tissue. The tibial nerve runs through it alongside several tendons and blood vessels, then divides into branches that supply the sole of the foot. Tarsal tunnel syndrome happens when the nerve is squeezed or irritated in this space — it is sometimes described as the foot's version of carpal tunnel syndrome in the wrist.
The typical symptoms are burning, tingling, pins and needles or numbness on the inside of the ankle and spreading into the sole, arch, heel or toes. Symptoms are often worse after long periods of standing or walking and can be troublesome at night. Tapping over the inner ankle may send tingling into the foot. Because the pain can be felt in the heel and arch, it is sometimes mistaken for plantar fasciitis.
Tarsal tunnel syndrome is less common than many other causes of foot pain. It can follow an ankle sprain or fracture, or be linked to flat feet, swelling in the ankle, or general health conditions that make nerves more sensitive. Many people improve with conservative care, although outcomes vary and some need further tests to confirm the diagnosis.
Causes and risk factors
- Flat feet or overpronation, which can stretch and compress the nerve
- A previous ankle sprain or fracture
- Swelling around the inner ankle from tendon problems or ankle arthritis
- Something taking up space in the tunnel, such as a cyst, a varicose vein or a bony spur
- Health conditions that affect nerves, such as diabetes, thyroid problems or inflammatory arthritis
- A sudden increase in standing, walking or running
- Tight shoes, boots or straps pressing on the inner ankle
How we may be able to help
Assessment first. We test the nerve with specific tapping and provocation tests, check sensation and strength in the foot, and work out whether the symptoms come from the tarsal tunnel or from something else — plantar fasciitis, a nerve root problem in the lower back, or a more general nerve condition that affects both feet. If nerve conduction studies, an ultrasound scan or an MRI would help, we can arrange an online private GP consultation for referral.
Our 3D foot scan assesses whether foot posture is adding tension to the nerve. Where flat feet or overpronation are contributing, custom orthotics manufactured in the UK can support the arch and aim to reduce strain on the inner ankle.
Physiotherapy includes gentle nerve-gliding exercises to help the nerve move more freely, strengthening of the muscles that support the arch, manual therapy for stiff foot and ankle joints, and advice on footwear and activity. Interferential therapy may be used for short-term pain relief in some plans. If symptoms do not improve as expected, we will discuss further assessment with you.
What you can do at home
- Wear supportive shoes and avoid tight laces, straps or boot tops over the inner ankle
- Break up long periods of standing with short rests and position changes
- Keep the ankle and toes moving gently through the day
- Avoid positions that press on the inner ankle, such as sitting cross-legged on the floor
- Raise the foot for a while in the evening if the ankle tends to swell
- Keep a note of when symptoms come on, and tell us if numbness spreads or the foot feels weaker
Frequently asked questions
How is tarsal tunnel syndrome different from plantar fasciitis?
Plantar fasciitis typically causes a sharp pain under the heel with the first steps in the morning. Tarsal tunnel syndrome is a nerve problem, so it more often causes burning, tingling or numbness that can spread across the sole, and tapping the inner ankle may reproduce it. The two can be confused, which is why a careful assessment matters.
Do I need nerve tests or a scan?
Not always. If the diagnosis is unclear, symptoms are severe or they are not improving with care, nerve conduction studies, an ultrasound scan or an MRI may be considered. We can arrange an online private GP consultation for referral.
Will orthotics help?
If flat feet or overpronation are adding tension to the nerve, custom orthotics may help by supporting the arch. They are not helpful for every case, so we use the 3D foot scan and your examination to decide whether they are worth trying.
Will I need surgery?
Most people start with conservative care. If symptoms persist despite this, or if a scan shows something pressing on the nerve, a specialist opinion may be worthwhile, and we can help arrange this through an online private GP consultation.
This page is general information, not a diagnosis. A clinician will assess you before recommending any treatment. Outcomes vary from person to person. Written with reference to NHS and other peer-reviewed guidance.