What is tarsal tunnel syndrome?

Tarsal tunnel syndrome is a compressive neuropathy of the posterior tibial nerve as it passes through the tarsal tunnel. The tunnel refers to a space behind the medial malleolus and underneath the flexor retinaculum at the ankle.

What causes it?

It can be due to anatomical abnormalities: 

  • Ganglion, cyst, lipoma, talus ossicle
  • Osteophytes from ankle osteoarthritis
  • Ankle deformities following trauma
  • Severe flat feet  
  • Tenosynovitis associated with rheumatoid arthritis or diabetes mellitus

It can occur without any obvious reason (Idiopathic):

  • However it may be more commonly seen in active adults.

Symptoms & Signs

  • Pins & needles, tingling sensation affecting the sole of the foot
  • The symptoms can be nocturnal with night waking
  • It may also lead to numbness in the foot and burning pain at the ankle
  • The symptoms tend to be worse after prolonged standing or walking
  • The symptoms are relieved by elevation and rest
  • In severe cases, there may be wasting of the medial intrinsic muscles of the foot
  • Tinel's sign along the course of the nerve may correspond to the site of compression


The diagnosis remains clinical. Neurophysiology is used to confirm the diagnosis. Xrays of the ankle/foot are requested in patients with deformities or arthritis. MRI may be helpful in delineating any space occupying lesion.



  • Activity modification 
  • Orthotics
  • Pain killers
  • Steroid (cortisone) injection 


  • In those who fail to respond to nonoperative treatment, surgical release of the flexor retinaculum can be considered. 
  • In those with a definite space occupying lesion, surgical excision of the lesion is recommended. 

What should I expect when undergoing a tarsal tunnel release?

  • It is performed as a day-case procedure, under general or regional anaesthesia.
  • At the end of the procedure, a bulky dressing is applied over the ankle and foot.
  • The dressing is reduced within 5 days and the wound is expected to heal within 2 weeks.

What are the risks?

Tarsal tunnel release is successful in the majority of patients. There are however recognised risks of wound infection, nerve injury, pain syndrome, incomplete recovery and recurrence.  


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