If you feel burning, tingling or numbness on the inside of your ankle or the bottom of your foot that worsens when you stand or walk, you might have a condition called tarsal tunnel syndrome.

“The tarsal tunnel is a passageway on the inside of the ankle that contains muscles, tendons, arteries, veins, and a nerve,” says Matthew Murray, a physical therapist with Harvard-affiliated Spaulding Outpatient Center Malden. Tarsal tunnel syndrome occurs when the nerve (called the tibial nerve) is compressed.

Some people experience pain or weakness in addition to the nerve sensations. Symptoms can come and go at first before becoming more persistent.

What causes tarsal tunnel syndrome?

Anything that crowds or irritates the tibial nerve can lead to tarsal tunnel syndrome, including flat feet or excessive pronation (in which the feet roll inward too much). “When you have a flat foot posture, the structures inside the foot get stretched, which can lead to irritation,” says Murray.

Other changes that can impinge on the nerve include:

How is tarsal tunnel syndrome diagnosed?

Before you assume you have tarsal tunnel syndrome, keep in mind that other foot problems have similar symptoms.

“We need to rule out more common foot conditions, such as plantar fasciitis and lumbar radiculopathy,” says Murray. With lumbar radiculopathy, a pinched nerve in the lower spine can cause tingling and numbness in the foot. Plantar fasciitis occurs when the plantar fascia, a fibrous band of tissue on the bottom of the foot that helps support the arch, becomes overloaded or overstretched. The fascia loses some of its elasticity and becomes inflamed, resulting in pain in the heel or sole of the foot, or both.

To diagnose tarsal tunnel syndrome, your doctor will ask you to describe your symptoms. “More burning, numbness, and tingling rather than dull and achy pain indicates a problem with a nerve,” says Murray. Your clinician or a specialist will examine the foot and ankle, pressing along the tarsal tunnel to see whether the symptoms recur.

How is tarsal tunnel syndrome treated?

“Changes to a routine like starting a new training program, suddenly increasing running or walking, or even switching footwear can trigger the onset of symptoms,” says Murray. Stepping back from an activity may allow an irritated nerve to calm down. Treatment of an underlying condition (such as arthritis) can help as well.

“The next thing we look at for tarsal tunnel syndrome treatment is shoes and orthotics,” says Murray. These should provide arch support to keep your foot from rolling inward.

To further ease symptoms, a physical therapist can teach you exercises for tarsal tunnel syndrome (see “Targeted therapy for nerves, joints, and muscles”).

Targeted therapy for nerves, joints and muscles

To treat tarsal tunnel syndrome, you’ll work with a physical therapist to achieve these goals:

Increase nerve mobility.“The most important exercises are nerve glides,” says Murray. These gentle movements help the nerve slide and move more freely within the tarsal tunnel. While they are the most effective interventions, doing them incorrectly may worsen symptoms. You should do these only under the guidance of a physical therapist.

Improve motion in the ankle joint. People whose feet roll too far inward too when walking or running (overpronate) may have trouble bending the foot upward, often because of tightness in the calf muscle. You can improve flexibility with exercises that stretch these muscles or with massage. For ankle stiffness, a physical therapist can gently move the joint and teach you exercises to do at home.

Strengthen muscles. Strengthening the muscles that help hold up the arch of the foot and the small muscles in the foot that control your toes can reduce strain around the tarsal tunnel. You might try toe yoga: for example, press your big toe down while lifting the other toes, and then lift the big toe while pressing the others down.

How long does tarsal tunnel syndrome last?

Recovery time varies, but many people see improvements within about two months. Long-term or severe cases may take longer.

If the condition persists, your clinician may give you a steroid injection to reduce pain and inflammation. Surgery is an option when the problem is due to nerve compression and severe symptoms don’t improve with nonsurgical treatments. Surgical procedures can widen the tarsal tunnel, release the tibial nerve, or remove masses pressing on the nerve.

(Lynne Christensen is a staff writer for Harvard Health Publications.)

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