Quick Summary
Tarsal tunnel syndrome occurs when the posterior tibial nerve is compressed or irritated as it passes through a narrow channel on the inside of your ankle, producing burning, tingling or numbness across the sole of your foot.
Our HCPC-registered physiotherapists in New Malden combine hands-on manual therapy with nerve mobilisation techniques and a targeted exercise programme designed to reduce pressure on the nerve and restore comfortable walking and standing. Research suggests most people improve with conservative care, and many patients notice a meaningful change within six to eight sessions, although your programme will always be shaped around your assessment findings.
What Is Tarsal Tunnel Syndrome?
The tarsal tunnel is a narrow channel on the inner side of your ankle, just behind and below the bony bump of the medial malleolus. Its roof is formed by a band of connective tissue called the flexor retinaculum, and it carries the posterior tibial nerve alongside tendons, an artery and a vein into the sole of the foot. Within or just beyond the tunnel, the nerve divides into the medial plantar, lateral plantar and medial calcaneal branches that supply sensation to your sole and heel.
When the space inside the tunnel is reduced, or when the nerve is placed under repeated traction, pressure builds within the nerve itself. This impairs its blood supply and the internal transport of nutrients along the nerve fibres, which is why symptoms usually begin as altered sensation — burning, pins and needles or numbness — before any weakness develops. Longer-standing compression may progress to weakness or wasting of the small muscles within the foot.
An identifiable underlying cause is found in roughly 60 to 80 per cent of cases, including space-occupying lesions such as ganglia or enlarged veins, a flattened arch or inward-rolling heel that stretches the nerve, previous ankle trauma, or systemic conditions such as diabetes and inflammatory arthritis. The remainder are classified as idiopathic, meaning no single structural cause can be identified (Hoermann et al., 2024).
Tarsal tunnel syndrome is considerably less common than similar nerve compression at the wrist, and it is frequently mistaken for plantar fasciitis because both conditions cause pain underneath the heel. The distinction matters, because the two respond to quite different treatment approaches. Evidence shows that conservative management should be the first line of care, with one long-term follow-up study reporting satisfactory outcomes in around two-thirds of conservatively treated feet at five years (Bouysset et al., Foot & Ankle Specialist, 2026).
Do You Experience These Symptoms?
✓ Burning, tingling or numbness across the sole of your foot and the inside of your ankle
✓ Symptoms that worsen with prolonged standing, walking or activity, and settle with rest and elevation
✓ Pain that disturbs your sleep or feels worse at night
✓ Tingling that shoots into the foot when the area behind your inner ankle bone is tapped or pressed
✓ Symptoms reproduced when the ankle is held turned outwards and pulled upwards for a sustained period
✓ A sensation of walking on a pebble, or reduced ability to feel the ground beneath your foot
✓ In longer-standing cases, weakness or visible wasting of the small muscles within the foot
These symptoms can be treated.
The sooner you begin, the better your chances of a smoother recovery.
What Causes Tarsal Tunnel Syndrome?
• Space-occupying lesions within the tunnel
A ganglion, lipoma, enlarged vein, accessory muscle or thickened tendon sheath can occupy space inside an already narrow channel. This directly reduces the room available to the posterior tibial nerve and is one of the most commonly identified structural causes.
• Flat feet and inward-rolling heel posture
A fallen arch or a hindfoot that rolls inwards places the nerve under sustained traction each time you take a step. Over months this repeated stretching irritates the nerve, which is why footwear and arch support form such an important part of treatment.
• Previous ankle injury or surgery
Fractures, severe sprains and post-surgical scarring can alter the shape of the tunnel or leave adhesions that tether the nerve. Symptoms may appear months or even years after the original injury has otherwise settled.
• Systemic health conditions
Diabetes, rheumatoid and other inflammatory arthritis, an underactive thyroid and fluid retention all make nerve tissue more vulnerable to compression. Where these are present, we work alongside your GP so that the underlying condition is managed in parallel.
• Repetitive loading and sudden training increases
Long periods on your feet, rapid increases in running mileage or unsupportive footwear can inflame the tendons that share the tunnel with the nerve. The resulting swelling reduces the available space and provokes symptoms.
How We Treat Tarsal Tunnel Syndrome at J&J Therapy
Hands-On Manual Therapy
Our physiotherapists use hands-on techniques aimed at reducing pressure on the posterior tibial nerve and restoring normal movement through the foot and ankle. This includes neurodynamic nerve mobilisation to help the tibial nerve glide freely through the tunnel, soft tissue release of the flexor retinaculum and posterior tibial tendon, and mobilisation of the subtalar and ankle joints where stiffness is contributing to your symptoms. Research suggests that adding nerve mobilisation to conservative care may improve pain, sensation and range of movement (Kavlak and Uygur, 2011).
Shockwave Therapy*
For conditions involving direct nerve compression, our care emphasises specialised manual therapy and targeted exercises — the most appropriate approach for your specific needs. Shockwave therapy is not directed at a compressed nerve, and our assessment focuses instead on relieving pressure within the tunnel and restoring healthy nerve movement.
Targeted Exercise Programme
Your programme is built around the findings of your assessment and progresses as your symptoms settle. It typically includes gentle nerve gliding exercises, strengthening for the tibialis posterior and the small muscles that support your arch, calf and soleus flexibility work, and balance retraining. We also review your footwear and, where a flattened arch is loading the nerve, discuss whether supportive insoles or orthoses would help, alongside guidance on gradually returning to walking, standing and sport.
When to Seek Urgent Medical Help
While most symptoms are not serious, urgent medical attention is required if you experience any of the following:
Progressive weakness in your foot, difficulty lifting your foot clear of the ground, or rapidly spreading loss of sensation
A visible or palpable lump at the inside of your ankle, especially with night pain or rapid growth
Redness, heat, fever or a swollen, discoloured foot, which may indicate infection or a problem with the blood supply
Numbness affecting both feet, or numbness around the saddle area with any change in bladder or bowel control — seek emergency care immediately
FAQs About Tarsal Tunnel Syndrome
Is tarsal tunnel syndrome the same as plantar fasciitis?
No, although the two are often confused because both cause pain underneath the heel. Tarsal tunnel syndrome is a nerve problem and tends to produce burning, tingling or numbness that can spread across the sole, while plantar fasciitis causes sharp, localised heel pain that is usually at its worst during the first steps of the morning. Our assessment distinguishes between them so that your treatment targets the right structure.
Will it improve without surgery?
For most people, yes. Evidence shows that conservative management should be the first line of treatment, and a five-year follow-up study reported satisfactory outcomes in around two-thirds of conservatively treated feet (Bouysset et al., Foot & Ankle Specialist, 2026). Surgical decompression is generally reserved for people whose symptoms persist despite a well-structured programme of physiotherapy and footwear or orthotic support.
Do I need a nerve conduction test?
Not always. Nerve conduction studies can support the diagnosis, but they are not perfectly sensitive — one study found that routine testing identified around 61 per cent of cases (Abouelela and Zohiery, Egyptian Rheumatology and Rehabilitation, 2022). Diagnosis is primarily clinical, based on your history and examination findings. Where a structural cause such as a ganglion is suspected, we will refer you for ultrasound or MRI imaging.
Can shockwave therapy treat tarsal tunnel syndrome?
We do not use shockwave therapy to treat the compressed nerve itself. Research in this specific condition is very limited, and device manufacturer guidance advises against applying shockwave close to major nerves and blood vessels — both of which run together inside the tarsal tunnel. Occasionally an assessment identifies a separate, coexisting problem such as plantar fasciitis or posterior tibial tendinopathy that is driving part of your pain, and shockwave may then be considered for that structure alone, well away from the tunnel. Your physiotherapist will explain clearly if this applies to you.
What makes the symptoms worse?
Prolonged standing and walking, tight or unsupportive footwear and a flattened arch posture all tend to aggravate symptoms, while rest, elevation and good arch support usually ease them. Many people find their symptoms build through the day and are most noticeable in the evening or at night, which is a useful clue during assessment.
This page is for general information only and does not replace professional medical advice.
Reviewed by Lavya Arigalayan, MSc, HCPC Registered Physiotherapist.
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