What is tarsal tunnel syndrome?
Tarsal tunnel syndrome (TTS) is a condition caused by compression of the tibial nerve as it passes through the tarsal tunnel, a narrow passageway on the inside of the ankle. The tibial nerve is responsible for sensation and movement in the bottom of the foot and toes.
When the tibial nerve becomes compressed and squeezed within this tunnel, it can cause pain, tingling, numbness, and weakness that radiates through the ankle and into the foot. Tarsal tunnel syndrome is similar in concept to carpal tunnel syndrome, which affects the wrist.
What are causes of TTS?
Anything that increases pressure inside the tarsal tunnel can compress the tibial nerve and trigger symptoms. Common causes include:
- Flat feet or fallen arches
- Swelling resulting from an ankle sprain
- Diseases, like arthritis or diabetes, which cause swelling and nerve compression
- A varicose vein, ganglion cyst, swollen tendon or bone spur
- Cysts or benign tumors
What are the symptoms of TTS?
Tarsal tunnel symptoms typically affect the inside of the ankle and the bottom of the foot. They may come on gradually or appear suddenly following an injury. Common symptoms include:
- A burning, tingling, or electric shock-like sensation along the inside of the ankle and into the foot
- Numbness in the sole of the foot or toes
- Pain that worsens with prolonged standing, walking, or activity
- Symptoms that improve with rest
- A feeling of weakness in the foot
- Pain that radiates upward into the calf in some cases
Symptoms are often worse at night or after long periods on your feet. They can affect one or both feet.
How is TTS diagnosed?
Because symptoms of TTS overlap with other foot and ankle conditions, tarsal tunnel syndrome requires a thorough evaluation. Your provider will review your symptoms and medical history before performing a physical examination. An X-ray or MRI may be needed to check for bone spurs, fractures, soft tissue masses, or structural abnormalities that may be contributing to compression.
What are treatment options for TTS?
Treatment for tarsal tunnel syndrome is focused on relieving pressure on the tibial nerve and addressing the underlying cause. Many patients improve with non-surgical care, such as:
- Rest and activity modification
- Immobilization
- Custom shoe inserts to correct flat feet or other alignment issues
- Anti-inflammatory medications to reduce swelling around the nerve
- Corticosteroid injections to reduce inflammation and relieve pressure on the nerve
- Physical therapy to improve strength, flexibility, and foot mechanics
When conservative treatments have not provided adequate relief, surgery may be recommended. The procedure, called tarsal tunnel release, involves cutting the ligament that forms the roof of the tarsal tunnel to create more space for the tibial nerve. Most patients experience significant improvement in symptoms following surgery.
Last Medically Reviewed on April 29, 2026.