Ankle & Lower Leg

What It Is

Tarsal tunnel syndrome is a condition that occurs when the posterior tibial nerve is squeezed (compressed) as it passes through a narrow space on the inside of the ankle. The condition is similar to carpal tunnel syndrome in the wrist (ACFAS, n.d.). It can be quite difficult to diagnose and is thought to be under-diagnosed (Sha, 2024).

The tibial nerve runs into the foot behind the medial malleolus, which is the bump on the inside of the ankle. As the nerve enters the foot, it runs underneath a thick band called the flexor retinaculum, which forms a tunnel. Several tendons, as well as an artery, veins and the nerve, travel through the tunnel to the bottom of the foot. This is the tarsal tunnel (ACFAS, n.d.; Sha, 2024).

What Causes It?

Anything that presses on the nerve can cause it, such as a swollen tendon, a ganglion cyst, a varicose vein, an arthritic bone spur, swelling after an ankle sprain, or conditions such as diabetes or arthritis (ACFAS, n.d.). Flat feet are listed as a risk factor (ACFAS, n.d.), although a recent review found no direct link between flat feet and tarsal tunnel syndrome (Sha, 2024).

Tarsal Tunnel Syndrome Anatomy

The tarsal bones are called the calcaneus, talus, cuboid, navicular and three cuneiforms. They are the main bones in the foot, located mostly towards the middle and back of the foot. The tarsal tunnel lies on the inside of the ankle next to these bones and is covered by the flexor retinaculum (ACFAS, n.d.).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Symptoms

How It Feels

What are the Symptoms?

Tingling, burning or a feeling like an electric shock

Numbness

Pain, including shooting pain

Symptoms are usually felt on the inside of the ankle and/or the sole of the foot, and may spread to the heel, arch, toes or calf. They are often brought on by prolonged standing, walking or exercise (ACFAS, n.d.).

It is important to get symptoms checked early. If left untreated, the condition may progress and cause permanent nerve damage (ACFAS, n.d.).

Treatment

Self-Care & Treatment

How to Treat Tarsal Tunnel Syndrome

Physiotherapy, exercises and changes to activity are among the first treatments tried (Haq et al., 2024; ACFAS, n.d.). I can help ease the pain and the tight tissue around the nerve's path with hands-on work, exercises and advice on activity and footwear. See the My Approach tab for how I work.

1. Rest and Ice

Staying off the foot helps prevent further injury. Apply an ice pack with a thin towel between the ice and your skin for 20 minutes, then wait at least 40 minutes before icing again (ACFAS, n.d.).

2. Anti-Inflammatory Medication

The American College of Foot and Ankle Surgeons (ACFAS, n.d.) says non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce pain and inflammation. (This medicine information comes from the American College of Foot and Ankle Surgeons, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

3. Orthotics and Footwear

Custom shoe inserts may be prescribed to help support the arch and limit movement that can press on the nerve, and supportive shoes may be recommended (ACFAS, n.d.). I can help you work out what might help and how to get it, and point you to a chiropodist or podiatrist if you need custom inserts.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Injections: an injection of local anaesthetic can relieve pain, and a corticosteroid injection may help treat inflammation (ACFAS, n.d.).
Immobilisation or bracing: a doctor may sometimes restrict foot movement with a cast, or fit a brace to reduce pressure (ACFAS, n.d.).
Surgery: if non-surgical treatment does not help, an operation to release pressure on the nerve (decompression) may be considered (Haq et al., 2024; ACFAS, n.d.).

How I can help (see the My Approach tab)

Hands-on work for the calf, ankle and foot

Gentle nerve glides and exercises

Activity and footwear advice

Tips

An anti-inflammatory medication should only really be used in the short term; ask your pharmacist or your family doctor or nurse practitioner.
Try a course of conservative treatment such as physiotherapy before surgery is considered (Haq et al., 2024). I can support this kind of non-surgical care.
See a professional promptly if you have tingling, burning or numbness in your foot (ACFAS, n.d.).

Treatment

My Approach

Tarsal tunnel syndrome is pressure on the nerve that runs behind the bump on the inside of your ankle. My aim is to ease the tight tissue along the nerve's path, help you change what keeps stirring it up, and watch for any sign that you need medical care first.

I start by assessing how your foot and ankle move and how your foot behaves when you stand and walk, and I screen the nerve: sensation, reflexes and strength in your foot and leg. That tells us which path you're on.

If It's Mild

Tingling, burning or pain without weakness, and numbness that isn't getting worse, is something I can treat directly.

Hands-on work for the calf and the muscles along the inside of the shin and the sole of the foot, keeping firm pressure off the nerve itself
Gentle nerve glides within comfort, with a home version; any tingling should fade straight away, and if it lingers we ease off
Warm or cool applications in the clinic, and I'll show you how to use ice safely at home
Cutting back the standing, walking or exercise that brings it on, then building it back up gradually
Strength work for the foot and lower leg, and help working out whether supportive shoes or an insert might help

If It's More Severe

Weakness in your foot, numbness that is constant or getting worse, or symptoms that keep spreading need to be checked by your family doctor or nurse practitioner first. Then I can support their plan with gentle hands-on work for the calf and foot and gentle movement. After surgery to release the nerve, I need your surgeon's okay before any hands-on treatment; then I can help with scar work, swelling and getting your strength back.

If you have diabetes or reduced feeling in your feet, I use lighter pressure and only mild warm or cool applications, and at home always test water temperature with your hand first.

What to Expect

Typical Course

Typical course: For mild symptoms, most people come once or twice a week at first, then weekly, then every few weeks as you manage more on your own, with a reassessment at about 4 to 6 weeks; improvement usually takes weeks to months rather than days. For more severe symptoms, visits and timeline follow your medical team's plan, and recovery can take longer.

What I Focus On

Nerve Screening

Calf & Foot Release

Gentle Nerve Glides

Load & Footwear Advice

Return to Activity

Sources

References

American College of Foot and Ankle Surgeons (n.d.) Tarsal tunnel syndrome. FootHealthFacts. Available at: https://www.foothealthfacts.org/conditions/tarsal-tunnel-syndrome (Accessed: 7 October 2026).
Sha, I.I. (2024) 'Tarsal tunnel syndrome – a comprehensive review', Iowa Orthopaedic Journal, 44(2), pp. 32–36.
Haq, I.I., Banerjee, A.A., Arshad, Z. et al. (2024) 'The management of tarsal tunnel syndrome: a scoping review', Journal of Clinical Orthopaedics and Trauma, 54, 102489. doi: 10.1016/j.jcot.2024.102489

Massage therapy · Kitchener–WaterlooTarsal Tunnel Syndrome

What It Is

What Causes It?

Tarsal Tunnel Syndrome Anatomy

How It Feels

What are the Symptoms?

Self-Care & Treatment

How to Treat Tarsal Tunnel Syndrome

1. Rest and Ice

2. Anti-Inflammatory Medication

3. Orthotics and Footwear

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

If It's Mild

If It's More Severe

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooTarsal Tunnel Syndrome

What It Is

What Causes It?

Tarsal Tunnel Syndrome Anatomy

How It Feels

What are the Symptoms?

Self-Care & Treatment

How to Treat Tarsal Tunnel Syndrome

1. Rest and Ice

2. Anti-Inflammatory Medication

3. Orthotics and Footwear

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

If It's Mild

If It's More Severe

Typical Course

References

Related Conditions

Common Peroneal Nerve Entrapment

Ankle Impingement (Anterior)

Ankle Osteoarthritis

Ankle Pronation (Overpronation)

Book a session