Condition & Treatment
Burning, tingling, and numbness along the bottom of the foot and inner ankle — caused by compression of the posterior tibial nerve as it passes through the tarsal tunnel. Often misdiagnosed as plantar fasciitis.
Dr. Bregman offers comprehensive tarsal tunnel evaluation — including nerve conduction studies, advanced imaging, and diagnostic nerve blocks — and the full range of treatment options from conservative care to tarsal tunnel release surgery.
Frequently Misdiagnosed as Plantar Fasciitis
Tarsal tunnel syndrome and plantar fasciitis share overlapping symptoms — heel and arch pain that is worse with activity. Many patients with tarsal tunnel syndrome are treated for plantar fasciitis for months or years before the nerve compression is identified. If your heel pain has not responded to standard plantar fasciitis treatment, a nerve-focused evaluation is warranted.
Symptoms
Causes
Treatment
First-line treatment includes custom orthotics to correct overpronation, anti-inflammatory measures, activity modification, and physical therapy. Appropriate for mild to moderate cases and as initial treatment in all cases.
Corticosteroid injections into the tarsal tunnel can reduce inflammation and provide temporary or lasting relief. Glucopuncture may be used as an adjunct to reduce nerve hypersensitivity.
Surgical release of the flexor retinaculum to decompress the posterior tibial nerve. Any structural cause of compression (cysts, varicosities, scar tissue) is addressed at the time of surgery. This is an outpatient procedure with a recovery period of several weeks.
Common Questions
Tarsal tunnel syndrome is compression of the posterior tibial nerve as it passes through the tarsal tunnel — a narrow passageway on the inner side of the ankle. It is the foot and ankle equivalent of carpal tunnel syndrome in the wrist.
Causes include space-occupying lesions within the tunnel (ganglion cysts, lipomas, varicosities), flat feet (overpronation) that stretch the nerve, ankle fractures or sprains that cause scar tissue formation, and systemic conditions like diabetes or hypothyroidism that affect nerve health.
Diagnosis requires a thorough clinical examination including Tinel's sign (tapping over the tarsal tunnel to reproduce symptoms), nerve conduction studies, and imaging (MRI or ultrasound) to identify any structural cause of compression.
Yes — many patients respond to conservative treatment including orthotics, physical therapy, anti-inflammatory measures, and targeted injections. However, when a structural cause is identified (such as a cyst or varicosity) or when conservative treatment fails, surgery is often the most effective option.
Tarsal tunnel release surgery involves cutting the flexor retinaculum (the ligament that forms the roof of the tunnel) to relieve pressure on the posterior tibial nerve. Any structural cause of compression (cysts, varicosities, scar tissue) is also addressed at the time of surgery.
Tarsal tunnel syndrome is frequently missed because its symptoms overlap with plantar fasciitis and other common conditions. Many patients are treated for plantar fasciitis for months or years before the nerve component is identified. A nerve-focused evaluation is essential for accurate diagnosis.
If your heel or ankle pain has not responded to standard treatment, a nerve-focused evaluation may identify tarsal tunnel syndrome as the true cause.