Tarsal tunnel syndrome
Tarsal tunnel syndrome is a nerve condition affecting the ankle, caused by compression of the posterior tibial nerve. Learn about it.
The tarsal tunnel is located on the inner side of the ankle, towards the back. It is bordered by the bones of the foot and a thick ligament called the flexor retinaculum. When pressure builds up inside this confined space, the nerve is squeezed, leading to neurological symptoms in the foot. These symptoms are comparable to those of carpal tunnel syndrome in the wrist.
This condition causes pain, burning sensations, tingling or numbness in the sole of the foot. It can interfere with walking and significantly affect quality of life if left untreated.
Tarsal tunnel syndrome causes
Tarsal tunnel syndrome causes are often multifactorial. Several mechanisms can lead to nerve compression, and identifying the underlying cause is essential because treatment depends directly on the origin of the problem. The most common causes include the following.
These are the most frequent causes.
- Flat feet or collapsed arches: the altered alignment of the foot increases tension on the nerve.
- Hindfoot deformity (valgus).
- Bony outgrowths or post-traumatic irregularities.
- Previous fracture or severe ankle sprain.
- Scar tissue from prior local surgery.
In these situations, the space within the tarsal tunnel becomes too narrow for the nerve.
Local inflammation can cause swelling of the tissues surrounding the nerve, including:
- Tendinitis of the flexor muscles
- Inflammatory joint diseases
- Chronic ankle oedema
The increase in volume within a closed space results in nerve compression, triggering tarsal tunnel syndrome.
Certain lesions can compress the nerve directly:
- Synovial cyst
- Lipoma
- Local varicose veins
- Benign tumour (less commonly)
In some cases, the patient’s medical background may predispose them to nerve damage:
- Diabetes
- Peripheral neuropathy
- Metabolic disorders
These conditions can worsen an existing compression or make the nerve more vulnerable.
In cases of tarsal tunnel syndrome feet, it is not uncommon for several factors to overlap. For example, flat feet combined with local inflammation following an injury.
This is why a specialist assessment is essential to pinpoint the exact source of the compression, tailor the treatment to the actual cause and avoid incomplete management.
Tarsal tunnel syndrome diagnosis test
The tarsal tunnel syndrome diagnosis test process relies on a methodical approach combining a specialist clinical examination and targeted imaging. The first step involves a detailed discussion with the patient.
The surgeon looks for:
- Pain on the inner side of the ankle or in the sole of the foot
- Burning sensations, tingling or electric shock-like feelings
- Worsening of symptoms after prolonged walking or at the end of the day
- Any previous injury, surgery, or foot deformity
This interview helps to guide the diagnosis and assess the functional impact on daily life. A physical examination is then carried out.
The surgeon palpates the tarsal tunnel area and checks for a Tinel’s sign (tingling triggered by tapping on the nerve). Sensitivity in the sole of the foot is also assessed. The surgeon evaluates ankle and foot mobility, posture and overall shape, checking for conditions such as flat feet, hallux valgus, or other ankle problems.
To confirm the diagnosis and identify the precise cause of the compression, imaging tests may be ordered: electromyography (EMG), MRI, or ultrasound.
An accurate diagnosis is essential to determine the most appropriate treatment. In some cases, conservative management is sufficient, while in others, targeted surgical intervention may be considered.
Tarsal tunnel syndrome symptoms
Tarsal tunnel syndrome symptoms are primarily neurological, as they result from compression of the posterior tibial nerve. These clinical signs may develop over time, and are often intermittent at first.
Pain is felt on the inner side of the ankle, under the arch, in the heel, and sometimes in the toes. Patients often describe it as deep and diffuse, with a burning quality and electric shock-like sensations.
The pain typically worsens with movement (walking, sport) or prolonged standing. It may also intensify at the end of the day and occasionally occur at night. This type of tarsal tunnel syndrome inside ankle tendon pain is one of the most recognisable features of the condition.
Nerve compression frequently leads to tingling (paraesthesia), a pins-and-needles sensation, and numbness in the sole of the foot. These sensations may be constant or come and go in episodes.
Some patients report a feeling of warmth in the foot, a sense of internal tension, or a diffuse discomfort that is difficult to pinpoint. Despite these sensations, visible swelling is not always present.
In more advanced or untreated cases, additional symptoms may appear:
- Rapid fatigue when walking
- Difficulty standing for long periods
- Reduced strength in certain foot muscles (rare)
The symptoms of tarsal tunnel syndrome can sometimes be misleading, as they may resemble other conditions such as plantar fasciitis, lumbar nerve compression, or peripheral neuropathy.
You should seek medical advice when:
- Pain persists for several weeks
- Tingling becomes regular
- Walking becomes uncomfortable or limited
- Symptoms interfere with sleep
How to treat tarsal tunnel syndrome
There are several approaches when it comes to treating tarsal tunnel syndrome, depending on the stage of the condition and the patient’s individual situation.
In many cases, tarsal tunnel syndrome can initially be managed conservatively, particularly when the nerve compression is moderate or recent. This type of care can greatly improve the situation and may even eliminate symptoms altogether. Non-surgical treatments include:
- Rest and activity modification
- Custom-made orthotic insoles
- Medication (non-steroidal anti-inflammatory drugs, analgesics, etc.)
- Targeted corticosteroid injections
- Specialist physiotherapy
When conservative treatments fail to provide sufficient improvement, or when a clear source of nerve compression is identified on imaging, targeted surgical intervention may be recommended. Several procedures are available depending on the indication.
This is the standard procedure for treating tarsal tunnel syndrome.
The procedure involves:
- Opening the ligament (flexor retinaculum) that forms the roof of the tunnel
- Decompressing the posterior tibial nerve
- Releasing the plantar branches if necessary
This procedure increases the space around the nerve and immediately reduces the pressure exerted on it.
The operation is performed by surgeons at International Elite Care with great precision to protect the surrounding vascular and nerve structures.
If imaging reveals an identifiable cause (cyst, lipoma, varicose vein, scar tissue), the surgery includes:
- Removal of the offending mass
- Complete release of the nerve
- Verification that no residual compression remains
Treating the underlying mechanical cause significantly improves the chances of lasting recovery.
In some cases, particularly when significant flat feet or hindfoot misalignment are present, an additional corrective procedure may be considered. The aim is to:
- Rebalance weight distribution
- Reduce chronic strain on the nerve
- Prevent recurrence
This option is considered carefully, following a thorough assessment.
Post-operative recovery after tarsal tunnel syndrome treatment
The procedure is most often performed as a day case or with a short hospital stay. Discharge is usually possible on the same day or the following morning. Depending on the patient’s needs, International Elite Care can arrange transfers between the clinic and their accommodation.
Weight-bearing is permitted relatively quickly, following the surgeon’s recommendations. Can you walk with tarsal tunnel syndrome surgery recovery? Yes, but walking should remain cautious and supervised during the first few weeks. A specific post-operative shoe may be recommended depending on the case.
The goal is to avoid excessive strain on the operated area, allowing it to heal properly. The wound is kept clean and protected as much as possible, and the scar is regularly monitored by the medical team.
Depending on the patient’s profile, physiotherapy may be prescribed to:
- Loosen the tissues
- Optimise ankle mobility
- Support functional recovery
- Prevent stiffness
A gradual return to activities is tailored to the pace of recovery.
As a general rule, mechanical pain decreases within a few weeks. Burning sensations and tingling may take several months to fully resolve. A medical clearance is required before resuming sport.
The structured support offered by International Elite Care ensures an optimised recovery and a safe return to daily activities.
Your questions about tarsal tunnel syndrome answered
Can tarsal tunnel syndrome go away on its own?
It is possible for the condition to improve with appropriate treatment and correction of mechanical factors.
However, when nerve compression persists, symptoms tend to become established. A specialist opinion helps determine quickly whether simple management is sufficient or whether more targeted treatment should be considered to prevent the condition from worsening.
Can you get tarsal tunnel syndrome in both feet?
Yes, it is possible to develop tarsal tunnel syndrome in both feet at the same time, although this is less common. Bilateral involvement is generally observed when there is a shared anatomical or biomechanical factor affecting both feet, such as pronounced flat feet, an alignment disorder, or certain metabolic conditions.
Management follows the same principles as for a single side. Surgery is not usually performed on both feet simultaneously. A sequential approach is preferred to maintain walking comfort and optimise recovery.
Is surgery always necessary?
No. Surgery is only considered when non-surgical treatments have proven insufficient or when a specific cause of compression has been clearly identified. The decision is based on a thorough evaluation. When surgery is proposed, it addresses a precise and measured objective, with the benefit-to-risk ratio carefully analysed.
Is the procedure a major operation?
Tarsal tunnel release is a targeted procedure carried out with precision, most often as a day case. It generally does not require an extended hospital stay. Recovery is typically straightforward, with a gradual return to walking. The protocol is personalised according to the patient’s profile and lifestyle.
How long does tarsal tunnel syndrome last after treatment?
It depends on the duration and severity of the initial compression. Mechanical pain often improves quickly, while neurological symptoms may require several weeks to fully resolve. Close follow-up optimises recovery and ensures a safe return to professional or sporting activities.
Is tarsal tunnel syndrome a disability?
While it is not typically classified as a disability in itself, untreated or severe forms can significantly limit mobility and daily function. In some cases, the impact on a patient’s ability to walk, stand or work may warrant formal assessment. Early treatment greatly reduces the risk of long-term functional impairment.
I live abroad: how can I organise my care?
A coordinated pathway allows every step to be planned remotely. A pre-operative teleconsultation is arranged to review your medical file, imaging results and establish a personalised treatment plan before you travel. The team then organises your medical stay, hospital admission and post-operative follow-up, including after your return home. You benefit from structured, secure support tailored to your international requirements.
Surgeon performing the procedure
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