tarsal tunnel syndromeTarsal tunnel syndrome occurs when the posterior tibial nerve that runs from the inside of your ankle to your foot (your tarsal tunnel) is squeezed or compressed. When this occurs you feel pain in the inner heel or arch which can radiate to other areas in your lower limbs.

What Causes Tarsal Tunnel Syndrome?

Anything that compresses the posterior tibial nerve can cause tarsal tunnel syndrome including:

  • Flat feet or high arches– people with these foot types tend to pronate causing compression on the nerve.
  • Acute and overuse injuries – an injury to the foot or ankle can put more stress on the nerve. Athletes are also at greater risk due to chronic overuse of the foot and ankle.
  • Inflammation and swelling – tendons and other structures can impinge on the tibial nerve if they become inflamed or swollen.
  • Abnormal growths – ganglion cysts, varicose veins, arthritic bone spurs, lipomas, and tumors can all cause pressure on the nerve.
  • Chronic conditions – certain chronic conditions like diabetes or arthritis can cause nerve compression.

Symptoms of Tarsal Tunnel Syndrome

You can experience any of the following symptoms if you have tarsal tunnel syndrome:

  • Burning
  • Tingling or “pins and needles”
  • Pain which can be shooting
  • Weakness in the foot muscles
  • Numbness

Most people feel the sensations on the inside of the ankle or on the bottom of the foot. But they can also be felt in the heel, arch, toes, and calf. Symptoms often feel worse during or after exercise.

Early diagnosis and treatment is essential to prevent permanent nerve damage.


It’s important to get a diagnosis to confirm the condition and to rule out other problems. Diagnosis is made clinically by percussing (tapping) over the nerve at the tunnel, which reproduces the symptoms.  A nerve conduction velocity test or MRI may also be ordered to confirm the diagnosis.  

Treatments for Tarsal Tunnel To Try at Home

Once you have a diagnosis of tarsal tunnel syndrome, you can try the following at home treatments:

  • Rest – stop all activity and stay off your foot as much as possible for several days
  • Ice – use ice packs or bags of frozen peas for 20 mins several times a day to reduce swelling and pain.
  • Compression and elevation
  • Over the counter non-steroidal anti-inflammatory medications

Treatments At the Podiatrist's Office

  • Custom orthotics to prevent your feet from pronating and compressing the tibial nerve.
  • Braces – to keep your foot from moving to promote healing.
  • Steroid injection – if your pain is great, a steroid injection can decrease the inflammation and pain quickly.
  • MLS laser – cold laser therapy can treat inflammation and pain and help the body repair itself.
  • Proper footwear – supportive shoes with a wider toe box can help prevent pronation and relieve pressure on the nerve.
  • Physical therapy – your therapist can offer ultrasound treatments and exercises to reduce symptoms.

Surgery for Tarsal Tunnel Syndrome

If conservate treatment has failed, your podiatrist may opt for surgery to release the tibial service or widen the tarsal tunnel. If other masses are impinging on the nerve, these may be removed.

Prevention of Tarsal Tunnel Syndrome

You can lower your risk of developing tarsal tunnel syndrome by:

To learn about other causes of heel pain visit:

What's Causing My Heel Pain and What Can I Do About It?

Dr. Rion Berg
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A podiatrist in North Seattle treating families for over 40 years.