# Tarsal tunnel syndrome > Tarsal tunnel syndrome is a squeezed nerve on the inside of the ankle, causing burning, tingling or numbness in the sole, heel or inner ankle. It's often missed. Simple care such as adjusting activity, stretching and supportive footwear is the usual first step, with injections or surgery kept for later. Guide in [Nerves and circulation](https://footanklelowerlimb.com.au/learn/topics/nerves-and-circulation), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/tarsal-tunnel-syndrome Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026. Next review by 27 October 2027. - **It's a squeezed nerve at the ankle,** causing burning, tingling or numbness in the sole, heel or inner ankle. - **It's often missed,** and can be mistaken for plantar fasciitis, so a proper assessment helps. - **Simple care comes first:** adjusting activity, stretching, nerve gliding exercises and supportive footwear. - **Injections and surgery are for later,** if simple care hasn't helped or a structural cause is found. - **Don't wait if it's getting worse,** because delay can raise the risk of lasting nerve damage. ## What is tarsal tunnel syndrome, and how common is it? Tarsal tunnel syndrome is a squeezing of the posterior tibial nerve as it passes under a tough band of tissue on the inside of your ankle [1]. This nerve runs down the back of your leg and into your foot [2]. It's often compared to carpal tunnel syndrome in the wrist [3]. It's less common than other nerve compression problems, and it's often overlooked or mistaken for plantar fasciitis (a common cause of heel and sole pain) [2]. Because it's so often missed, it's probably more common than the numbers suggest. A health professional needs to make the diagnosis. ## What causes it, and who gets it? Often no cause is found. Most cases are described as idiopathic (no clear cause) [3]. When there is a cause, it's usually local: a bone spur, a cyst, varicose veins, tendon inflammation, scarring or a past injury [4]. Rarely, an extra (accessory) muscle is responsible [5]. Conditions linked with it include diabetes, rheumatoid arthritis, an underactive thyroid and pregnancy [3]. Foot deformities and obesity are also named [2]. Runners may be more likely to get it, especially if the foot rolls inward [6]. These are links, not proven causes. A lump or cyst can sometimes be behind it, so it's worth having symptoms assessed rather than assuming overuse. Tell your clinician about any past ankle injury or surgery, diabetes, arthritis, thyroid problems, swelling and how much you run. ## What does it feel like, and how is it diagnosed? It typically causes burning pain, numbness and tingling in the sole, heel and inner ankle, sometimes reaching the inner foot and first three toes [4][2]. Symptoms often get worse with standing, walking or activity, and at night, and ease when you rest with your foot up [6][2]. No single test confirms it. A clinician works from your symptoms and an examination, and a nerve test called Tinel's sign is the one most often used [7]. Because there's no standard approach, practice varies [7]. A scan such as an MRI may be used if a lump is suspected [4]. A pinched nerve in the lower back can feel similar, though it usually affects one side. If both feet are affected, a wider nerve problem (polyneuropathy) should be ruled out [6]. If you have diabetes with existing nerve damage, tarsal tunnel syndrome is harder to pick out, and test results need careful interpretation [7]. ## What helps first? Start with simple care, ideally guided by a podiatrist or physiotherapist. Treatment usually begins with easing the activities that bring symptoms on, stretching, massage, taping and, for some people, medicines for nerve pain [7]. Calf stretching, nerve gliding (gentle exercises that move the nerve through its tunnel), strengthening the muscle behind the inner ankle and a wedge under the inner edge of the heel are also described. Simple care is often enough [6]. A podiatrist can tell you whether a heel wedge or shoe inserts suit you. How much each step helps isn't clear yet, and some people treated for it may turn out to have another condition [7]. If you're not improving, ask for a review. For pain relief, a GP or pharmacist can advise what's safe for you. Paracetamol and anti-inflammatory medicines are among those listed [6]. Avoid ice packs if you're sensitive to cold, have an open wound, poor circulation or reduced feeling of hot and cold [8]. ## What helps if that isn't enough? First, ask for the diagnosis to be confirmed, since other conditions can look like tarsal tunnel syndrome [6]. If simple care hasn't helped, or a structural cause such as a lump is found, surgery to free the nerve (decompression) may be considered [7]. Surgery carries risks, including poor wound healing, infection and scarring [6]. Before any operation, ask about the likely benefit, the recovery and the risks. A cortisone (corticosteroid) injection is another option. It carries a risk of tendon tear or rupture, so it's generally a last resort [8], and more than one injection is generally not recommended [2]. How well injections work once simple care has failed isn't clear yet. If you have diabetes, the role of surgery is debated [6], so discuss it carefully with your doctor. ## How long does it take to get better, and can it come back? How long recovery takes, how often it returns and what prevents that aren't clear yet. What is clear is that acting early matters: delay can raise the risk of irreversible nerve damage [2], and untreated or stubborn tarsal tunnel syndrome can lead to persistent pain, weakness and muscle wasting [6]. Get symptoms assessed early and follow the plan from your podiatrist, physiotherapist or doctor. It can help to ask how to reduce triggers in your situation, such as how much you walk or run and what footwear you wear. If symptoms persist, spread or come back, let your clinician know so the plan can be reviewed. ## When to see a podiatrist See a podiatrist or your GP if you have burning, tingling or numbness in the sole or inner ankle, so the cause can be found rather than assumed, or if it isn't easing with the self-care above. See your GP soon if: - your symptoms are getting worse or spreading [2]; - you notice weakness or thinning of the muscles in your foot [6]; - you feel or see a lump near the ankle [5]; - both feet are affected [6]; - aching in your arch, heel or calf when you walk eases with rest, which can point to a circulation problem [9]; - you have a cut or sore on your foot that isn't healing [10]. > [!see] If you have diabetes > Tarsal tunnel syndrome is linked with a higher risk of foot ulcers in people with diabetes [6]. See your GP or a podiatrist the same day if you have a wound, sore, blister or colour change on your foot. For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic. ## Common questions ### Is tarsal tunnel syndrome the same as plantar fasciitis? No, though they're easily confused. Plantar fasciitis usually causes a dull ache under the heel and arch that's worst with your first steps in the morning. Tarsal tunnel syndrome is a squeezed nerve, so it tends to cause burning, tingling or numbness, often worse at night. A podiatrist can help tell them apart. ### Do I need an MRI or nerve test to diagnose it? Not always. Diagnosis rests mainly on your symptoms and an examination. A scan such as an MRI may be used if a lump is suspected, and other tests may be used to help confirm the diagnosis or rule out similar conditions. Your clinician will decide what, if anything, you need. ### Can I keep running with tarsal tunnel syndrome? If you're a runner and notice burning or tingling in your sole, it's better to have it assessed than to train through it. Easing back on the activities that bring symptoms on is usually part of the first steps. A podiatrist or physiotherapist can help you plan how much to do. ## Further reading - [Tarsal tunnel syndrome on Clindice](https://clindice.com/tarsal-tunnel-syndrome) - [Tarsal tunnel syndrome: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000792.htm), MedlinePlus - [Tarsal Tunnel Syndrome](https://msk-bexley.nhs.uk/conditions/foot-and-ankle-pain/tarsal-tunnel-syndrome), NHS - [Foot and Ankle Pain Pathway (Age 16+)](https://www.dgft.nhs.uk/wp-content/uploads/2026/10/Foot-and-Ankle-Pain-v1.8.pdf), NHS ## Sources 1. Tarsal tunnel syndrome: A literature review · Ahmad M, Tsang K, Mackenney PJ et al. · Foot and Ankle Surgery · 2012. https://doi.org/10.1016/j.fas.2011.10.007 2. Overview of nerve entrapment syndromes in the foot and ankle · Bojovic M, Dimitrijevic S, Olory BCR et al. · International Orthopaedics · 2025. https://doi.org/10.1007/s00264-025-06469-5 3. Surgical interventions for entrapment and compression of the tibial and deep peroneal nerves including tarsal tunnel syndrome · Perera N, Liolitsa D, Hill CS et al. · PubMed Central (PMC) · 2017. https://doi.org/10.1002/14651858.cd010630.pub2 4. Rare entrapment neuropathies of the lower extremity: A narrative review · Drăghici NC, Bolchis R, Livinț Popa L et al. · Medicine · 2024. https://doi.org/10.1097/md.0000000000039486 5. Tarsal tunnel syndrome secondary to accessory or variant muscles: a clinical and anatomical systematic review · Yammine K, Daher JC, Tannoury EH et al. · Surgical and Radiologic Anatomy · 2022. https://doi.org/10.1007/s00276-022-02932-9 6. Tarsal tunnel syndrome: current rationale, indications and results · Rodríguez-Merchán EC, Moracia-Ochagavía I · EFORT Open Reviews · 2021. https://doi.org/10.1302/2058-5241.6.210031 7. Differences in Diagnosing Tarsal Tunnel Syndrome Across the Literature: A Systematic Review and a Call for Standardization · Boers N, Haverkamp M, Eligh AM et al. · JBJS Reviews · 2026. https://doi.org/10.2106/jbjs.rvw.25.00222 8. Tarsal Tunnel Syndrome · NHS. https://msk-bexley.nhs.uk/Portals/0/adam/Accordions/1DSzqVWYc0yNAQqiBJb20Q/Content/MSK%20Tarsal%20Tunnel%20Syndrome.pdf 9. Tarsal Tunnel Syndrome - A Comprehensive Review · Ibad Sha I · The Iowa Orthopaedic Journal · 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11726481/ 10. Peripheral neuropathy · NHS. https://www.nhs.uk/conditions/peripheral-neuropathy/ --- This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.