What is a tarsal tunnel syndrome?

Tarsal Tunnel Syndrome

Tarsal tunnel syndrome also called posterior tibial neuralgia is squeezing or compression on the posterior tibial nerve through the tarsal tunnel which is located on the inside of the ankle. Pain can be felt locally or anywhere along the nerve pathway.

Risk Factors

  • Certain occupations and activities involving repetitive and prolonged weight bearing
  • Recent change in activity
  • Diabetes
  • Inflammatory arthritis
  • Connective tissue disorders
  • Obesity
  • Varicosities
  • Heel inversion/eversion

Signs & Symptoms

Pain is limited to the medial side of the ankle
Pain is described as tingling, numb or burning sensation
Direct palpation can result in electric shock like symptoms
Aggravated by activity or prolonged standing
Relieved with rest


In most cases clinical assessment by your podiatrist can lead to diagnosis of tarsal tunnel syndrome, however in some cases imaging may be needed. This may include either a MRI or X-Ray to check the amount of compression through the tarsal tunnel.

Differential Diagnosis

Soft tissue: Plantar fasciitis, Achilles tendinitis, ankle sprain, bursitis, compartment syndrome

Skeletal: Osteophytes, stress fracture, arthritis

Neurological: Intermittent claudication (neurogenic), polyneuropathy, L5 and L1 nerve root compression


Conservative treatment will include; Activity modification, NSAIDs, strapping, immobilization, stretching, education, orthoses

Other more invasive treatments may be needed if there is no resolve including but not limited to;

  • Corticosteroid injections
  • Bracing
  • Surgery