Tarsal Tunnel Syndrome (Ankle Nerve Compression)

A condition caused by compression of the nerve in the inner ankle, resulting in burning and numbness in the sole of the foot.

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What is this Condition?

Tarsal tunnel syndrome occurs when the posterior tibial nerve, which passes through the inner ankle (behind the medial malleolus), becomes compressed in this narrow canal. It can be considered the foot equivalent of carpal tunnel syndrome in the wrist. Since the compressed nerve extends to the sole and heel, burning, numbness, and tingling in the foot sole are most common. Symptoms typically worsen with walking or prolonged standing and may disturb sleep. This condition is rarer than carpal and cubital tunnel syndromes and may be an overlooked cause of chronic foot pain. Causes include ankle trauma, flat feet, calcification, cysts, or conditions like diabetes.

Symptoms

Burning, numbness, and tingling in the sole of the foot

Sharp or aching pain in the heel

Symptoms that increase with walking or prolonged standing and improve with rest

Pain and discomfort that increase at night

Tingling radiating to the foot sole upon gentle percussion behind the medial malleolus

In advanced cases, weakness of intrinsic foot muscles; sometimes bilateral complaints

Diagnosis Methods

Diagnosis begins with physical examination. The physician evaluates Tinel's sign (tingling radiating to the foot sole upon gentle percussion behind the medial malleolus), assesses pain along the nerve pathway, and reproduces symptoms with specific ankle movements. Flat feet and foot muscle strength are also examined. EMG and nerve conduction studies support the diagnosis by measuring electrical transmission. MRI or ultrasound reveal cysts, calcification, or other masses within the canal.

Treatment Methods

Treatment typically begins with non-surgical approaches. Custom foot supports (particularly for flat feet), anti-inflammatory and analgesic medications, physical therapy, and avoiding prolonged standing benefit most mild-to-moderate cases. Corticosteroid injection into the canal may provide temporary relief. Underlying conditions such as diabetes are treated. If adequate improvement does not occur within several months or a mass compresses the nerve, surgery is considered. Surgical decompression relieves the compressed nerve by releasing the ligament causing compression. Reported success rates are higher with early diagnosis.

Custom foot support/orthosis (flat foot support)

Anti-inflammatory and analgesic medications, physical therapy, and activity modification

Corticosteroid injection into the canal (for temporary relief)

Surgical decompression (releasing the ligament causing compression, removal of cyst if present)

References

Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023:565.
Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011:2437–2438.
Waldman SD. Atlas of Common Pain Syndromes. 3rd ed. Philadelphia: Saunders/Elsevier; 2012:359–361.
Waldman SD. Atlas of Pain Management Injection Techniques. 4th ed. Philadelphia: Elsevier; 2017:624–628.

This content is based on academic sources and is for general information only; individual assessment requires a medical examination.

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Tarsal Tunnel Syndrome (Ankle Nerve Compression)

Peripheral Nerve Surgery

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

References

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