Tarsal Tunnel Syndrome: Know Why Your Foot Feels Numb

Burning pain, tingling or numbness around the inner ankle and sole of the foot may indicate tarsal tunnel syndrome.

This condition occurs when the tibial nerve or one of its branches becomes compressed as it passes through a narrow space behind the inner ankle bone.

Unlike tendon disorders, tarsal tunnel syndrome affects a nerve.

Symptoms may worsen during prolonged standing or walking and can interfere with exercise and everyday activities.

Recognizing the warning signs is important because this condition can resemble plantar fasciitis, ankle tendon problems and other nerve disorders.

What Is Tarsal Tunnel Syndrome?

The tarsal tunnel is a narrow passage on the inner side of the ankle.

Its roof is formed by a strong band of tissue called the flexor retinaculum, beneath which pass the tibial nerve, blood vessels and several tendons.

The tibial nerve divides into branches that provide sensation to much of the sole and contribute to the function of some foot muscles.

When the nerve is compressed or irritated, symptoms may develop along the areas it supplies.

Tarsal tunnel syndrome is a form of peripheral nerve entrapment.

Symptoms and severity vary according to the location and extent of compression, and some people develop the condition without an obvious cause (Sha, 2024)

What Causes Tarsal Tunnel Syndrome?

Ankle injuries and swelling

An ankle sprain, fracture or other injury can cause swelling or scar tissue around the tunnel.

These changes may increase pressure on the tibial nerve.

Cysts and other space-occupying lesions

Ganglion cysts, abnormal tissue growth and enlarged blood vessels can occupy space around the nerve.

Identifying such causes is important because treatment may need to address the underlying structure.

Foot alignment and repetitive loading

Certain foot alignment changes may contribute to pressure around the inner ankle in some people.

Repetitive weight-bearing activity may also aggravate symptoms, particularly when combined with other contributing factors.

However, flat feet do not automatically mean someone has tarsal tunnel syndrome, and exercise alone does not necessarily cause nerve compression.

Inflammatory and medical conditions

Tendon-sheath inflammation, inflammatory joint conditions and tissue swelling may contribute to compression.

Diabetes and other conditions affecting the peripheral nerves can also complicate the assessment.

Imaging can help identify potential causes, including cysts, tendon abnormalities, anatomical variations and post-traumatic changes (Khodatars et al., 2022)

What Are the Symptoms of Tarsal Tunnel Syndrome?

Burning pain around the inner ankle

Pain may develop behind the inner ankle bone and extend towards the heel, arch or sole.

Some people describe it as burning, shooting or electric rather than a dull ache.

Tingling and numbness

Pins and needles or reduced sensation may occur in the sole or toes.

The exact area depends on which part of the tibial nerve or its branches is affected.

Symptoms that worsen during activity

Prolonged standing, walking or running may aggravate symptoms.

Some people experience relief with rest, while others have persistent discomfort or symptoms at night.

Tenderness or tingling when the nerve is tapped

Tapping over the tibial nerve behind the inner ankle may reproduce tingling into the foot.

This is called a Tinel sign, but a positive result alone does not establish the diagnosis.

Weakness in more advanced cases

Significant or longstanding nerve involvement may affect small foot muscles and contribute to weakness.

Progressive weakness or persistent loss of sensation requires prompt medical assessment.

Not everyone experiences all these symptoms.

Burning foot pain can also arise from peripheral neuropathy, a nerve problem in the back or other conditions.

Is Tarsal Tunnel Syndrome the Same as Plantar Fasciitis?

No.

Both conditions can cause discomfort around the heel or sole, but they affect different structures.

Condition	Typical features
Tarsal tunnel syndrome	Burning, tingling or numbness around the inner ankle and sole
Plantar fasciitis	Pain beneath the heel, often prominent during the first steps after rest
Tibialis posterior tendinopathy	Pain along the inner ankle that may extend towards the arch
Peripheral neuropathy	Sensory symptoms that may affect both feet, depending on the cause
Lumbar nerve root irritation	Foot symptoms that may occur alongside back or leg pain, tingling or numbness

These patterns can overlap.

Clinical assessment helps distinguish nerve compression at the ankle from tendon disorders, plantar fascia problems and nerve conditions originating elsewhere.

How Is Tarsal Tunnel Syndrome Diagnosed?

Clinical and physiotherapy assessment

A clinician may ask about symptom location, previous injuries, medical history and activities that aggravate the pain.

The examination may include checking sensation, foot muscle strength, foot alignment, ankle movement and tenderness around the tunnel.

Provocative tests may help reproduce symptoms, but no single examination finding reliably confirms every case.

A 2026 systematic review found considerable variation in the diagnostic methods used in published studies, highlighting the absence of a universally accepted diagnostic standard (Boers et al., 2026)

Nerve conduction studies and electromyography

Nerve conduction studies and electromyography may help investigate suspected nerve dysfunction and distinguish tarsal tunnel syndrome from other neurological conditions.

However, these tests have limitations.

Normal findings do not necessarily exclude the condition, and results must be interpreted alongside the symptoms and physical examination (Patel et al., 2005)

Ultrasound, MRI and X-rays

• Ultrasound: May identify cysts, tendon abnormalities or other structures that could compress the nerve.
• MRI: Can provide detailed information about soft tissues and potential causes of compression.
• X-rays: May help assess bony abnormalities, fractures and foot alignment.

Not everyone needs every investigation.

The choice depends on the examination findings and whether a structural cause is suspected.

How Can Physiotherapy Help Tarsal Tunnel Syndrome?

Physiotherapy may help selected patients by modifying aggravating activities, improving comfortable movement and addressing contributing mechanical factors.

Treatment should be individualised because nerve compression does not have one universal rehabilitation programme.

1. Modify aggravating activities

Temporarily reducing activities that repeatedly trigger burning, tingling or numbness may help manage symptoms.

This might involve adjusting running distance, prolonged standing or high-impact exercise.

The aim is to maintain tolerable activity without repeatedly provoking nerve symptoms.

2. Review footwear and foot support

Tight footwear or pressure around the inner ankle may aggravate symptoms in some people.

A physiotherapist can assess shoe fit and determine whether arch-supporting insoles or other support may be appropriate.

Orthoses should not be prescribed automatically.

Their usefulness depends on foot structure, comfort and the factors contributing to compression.

3. Maintain comfortable ankle mobility

Gentle ankle movements may help maintain mobility when stiffness is present.

Exercises should remain within a comfortable range and should not reproduce increasing tingling, burning or numbness.

Aggressive stretching is not appropriate if it aggravates nerve symptoms.

4. Consider nerve mobilisation

A suitably trained physiotherapist may consider nerve-gliding exercises when clinically appropriate.

These movements aim to encourage controlled movement of the nerve relative to surrounding tissues.

They should not be forced or repeatedly performed through worsening symptoms.

Evidence specific to tarsal tunnel syndrome remains limited, so nerve mobilisation is an individualised option rather than a guaranteed treatment.

5. Address strength and movement control

If weakness, balance problems or altered foot mechanics are present, rehabilitation may include appropriately graded foot and ankle strengthening and functional training.

Strengthening alone may not resolve symptoms when a cyst, significant structural compression or another lesion is responsible.

A systematic review found that conservative treatments, including physiotherapy and orthoses, may help selected patients, but the available studies are limited.

Treatment therefore needs to reflect the cause and severity of compression (Vij et al., 2022)

Which Exercises Should You Avoid?

There is no universal list of exercises that everyone with tarsal tunnel syndrome must avoid.

However, activities that clearly aggravate nerve symptoms should be modified.

Be cautious with:

• Prolonged walking or running that increases burning or numbness.
• Tight footwear that compresses the inner ankle.
• Aggressive calf or ankle stretching that reproduces tingling.
• Repeated nerve-gliding movements that worsen symptoms.
• Balance or strengthening exercises that increase pain or cause loss of sensation.

Do not assume that nerve pain should be pushed through to improve mobility.

A physiotherapist can help identify an appropriate activity level and adjust exercises according to your response.

Can Tarsal Tunnel Syndrome Be Treated Without Surgery?

Many patients are initially considered for non-surgical management.

Depending on the cause, treatment may include activity modification, suitable footwear, orthoses, physiotherapy and medical management of contributing conditions.

However, conservative treatment is not sufficient in every case.

A cyst, significant injury, structural compression or progressive nerve deficit may require specialist assessment.

When Is Surgery Considered?

Surgical decompression may be considered when symptoms persist despite appropriate conservative treatment or when an identifiable structural cause requires intervention.

The procedure aims to relieve pressure on the tibial nerve.

Outcomes depend on factors such as the underlying cause, duration of symptoms, severity of nerve involvement and other medical conditions.

Surgery is not necessary for everyone with suspected tarsal tunnel syndrome.

A specialist should review the diagnosis and relevant investigations before recommending an operation.

When Should You Seek Medical Attention?

Arrange an assessment if burning, tingling or numbness around the inner ankle or sole persists, repeatedly returns or interferes with walking.

Seek prompt medical attention if you develop progressive weakness, worsening or persistent loss of sensation, or symptoms following a significant injury.

Sudden severe pain, a cold or discoloured foot, or rapidly developing neurological symptoms require urgent assessment.

Early evaluation is particularly important when symptoms are progressing, as prolonged nerve compression can sometimes cause lasting dysfunction.

Conclusion

Tarsal tunnel syndrome is a nerve compression condition that can cause burning pain, tingling and numbness around the inner ankle and sole.

Because it can resemble plantar fasciitis, tendon problems and other neurological conditions, accurate assessment is essential.

Physiotherapy may help selected patients through activity modification, suitable footwear, comfortable mobility work and individualised rehabilitation.

However, treatment must address the underlying cause, and persistent or progressive nerve symptoms should not be ignored.

Recognising the warning signs early can help guide appropriate treatment and support a safer return to walking, exercise and everyday activities.

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