Tarsal Tunnel Syndrome: Burning, Tingling or Numbness in the Sole
A pinched nerve behind the inner ankle that is often mistaken for plantar fasciitis. How to tell the difference, what helps, and what recovery from surgery really involves.
Tarsal tunnel syndrome is compression of the tibial nerve, or one of its branches, as it passes through the tarsal tunnel: a narrow channel behind and below the bony bump on the inside of the ankle. It typically causes burning, tingling, shooting pain or numbness along the inner ankle and the sole, usually worse after standing or walking and eased by rest.
It is far less common than carpal tunnel syndrome in the wrist, and easy to miss. In one surgical series, almost 94% of patients had previously been told they had plantar fasciitis. This guide from the podiatrists at ASG Foot & Ankle explains how the two differ, what causes the nerve to be squeezed, and what treatment and recovery honestly look like.
ASG Foot & Ankle patient education. Updated October 21, 2026. General information, not a diagnosis.
The short answer
Tarsal tunnel syndrome is a compressed tibial nerve at the inner ankle. It causes burning, tingling, numbness or shooting pain in the sole, usually in one foot and worse with standing and walking. Unlike plantar fasciitis, it behaves like nerve pain and can be present at rest. Treatment starts with foot support, activity changes, anti-inflammatories and nerve medicines, sometimes an injection. A tarsal tunnel release is reserved for persistent cases; published success rates range widely, from 44% to 96%, and the nerve can take up to a year to recover.
Have It Checked Promptly If
- •Numbness is spreading, or your toes feel weak or the arch muscles look thinner
- •You can feel a lump or swelling behind the inner ankle bone
- •Both feet are affected, which points toward a wider neuropathy that needs its own workup
- •You have diabetes and new numbness in the foot, since reduced feeling raises the risk of unnoticed sores
- •Symptoms run down the leg from the back or buttock, which can mean a pinched nerve in the spine
What the Tarsal Tunnel Is
The tarsal tunnel is a channel on the inside of the ankle. Its floor is formed by the shin, ankle and heel bones, and its roof is a tough band of tissue called the flexor retinaculum (or laciniate ligament) that runs from the inner ankle bone to the heel. Through it pass three tendons that move the foot and toes, an artery and veins, and the tibial nerve, which carries feeling to most of the sole and controls the small muscles of the foot.
Because the tunnel cannot stretch, anything that crowds it, from a swollen tendon to a cyst, presses on the nerve. The nerve divides into three branches around the tunnel, and which part of the sole tingles can hint at which branch is affected.
| Nerve branch | Area of feeling it supplies |
|---|---|
| Medial plantar nerve | The inner two-thirds of the sole, on the big toe side |
| Lateral plantar nerve | The outer third of the sole, toward the small toes |
| Medial calcaneal nerve | The heel pad. It often branches off above the tunnel, so the heel can be spared |
Tarsal Tunnel Syndrome Symptoms
- Burning, tingling, pins and needles or electric-shock sensations
- Numbness on the sole of the foot or in the toes
- Shooting pain from the inner ankle into the arch, heel or toes, sometimes up into the calf
- Worse with long periods of standing or walking, or after starting a new exercise routine
- Building through the day and easing with rest and elevation, though it can be noticeable at night
- A cold feeling in the foot, reported by about half of patients
- Usually one foot rather than both
- In long-standing cases, weakness or thinning of the small muscles in the arch
Night symptoms can appear when the foot rests turned outward and drawn up toward the shin, a position that stretches the nerve. Pain at rest tends to develop as the condition progresses.
Tarsal Tunnel or Plantar Fasciitis? The Look-Alikes
Several common problems cause pain in the heel and sole. The pattern of the symptoms usually separates them better than their location does.
| Feature | Tarsal tunnel syndrome | Plantar fasciitis | Peripheral neuropathy | Morton's neuroma |
|---|---|---|---|---|
| Where | Inner ankle and sole, spreading to heel, arch or toes | Underside of the heel | Toes and feet, creeping up the legs | Ball of the foot, between two toes |
| Feels like | Burning, tingling, electric, numb | Sharp or bruised ache | Burning, tingling, numb | A pebble in the shoe, burning into two toes |
| Timing | Builds with standing and walking; can linger at rest | Worst with first steps after rest, then eases | Often worse at night | Worse in tight shoes, relieved by taking them off |
| One or both feet | Usually one | One or both | Usually both | Usually one |
| Telling clue | Tapping behind the inner ankle sends tingling into the foot | A tender spot under the heel, toward the inner side | Diabetes or another whole-body cause | Pain between the toe bones, not at the ankle |
Two more look-alikes are worth knowing. A pinched nerve root in the lower back can send symptoms into the sole even without back pain. And Baxter's nerve, a small branch close to the tunnel, can be trapped under the heel, causing heel pain that runs into the arch. Heel and arch pain lasting more than six months that has not behaved like plantar fasciitis is a strong prompt to consider a nerve.
For the mechanical heel pain, see our plantar fasciitis healing timeline. For burning in both feet, see diabetic neuropathy in the feet.
What Causes Tarsal Tunnel Syndrome
A previous injury
Ankle sprains and fractures can leave swelling or scar tissue in the tunnel. More than 2 in 5 people with tarsal tunnel syndrome have a history of an injury such as a sprain.
Something taking up space
A ganglion cyst, a fatty lump or another benign growth accounts for roughly 1 in 5 cases in published series. Enlarged, varicose veins in the tunnel account for a similar share.
Foot shape and mechanics
With flat feet, the heel tilts outward and stretches the nerve. High arches and inflamed tendons from abnormal foot mechanics can also crowd the tunnel.
Conditions that affect nerves
Diabetes, an underactive thyroid, rheumatoid and other inflammatory arthritis, and kidney failure all make the nerve more vulnerable to pressure.
No identifiable cause
Depending on the study, anywhere from about 1 in 5 to just over half of cases have no specific cause. This is called idiopathic tarsal tunnel syndrome.
Finding the cause is not just academic. A cyst or a specific structural problem that can be removed or corrected generally does better with treatment than a nerve squeezed for no clear reason.
How It Is Diagnosed
There is no single definitive test. The diagnosis rests on the story and the examination, supported by nerve testing and imaging.
History and examination
Tapping just below the inner ankle bone may send tingling into the foot (Tinel's sign). Holding the ankle and toes pulled up with the foot turned out for 5 to 10 seconds reproduced symptoms in most affected feet, and in none of 100 normal feet, in the study that described the test.
Nerve conduction studies
Useful for supporting the diagnosis and checking for a wider neuropathy, but false negatives are common. A normal result does not rule tarsal tunnel syndrome out.
MRI or ultrasound
Shows whether a cyst, enlarged veins or another lesion is pressing on the nerve, which matters a great deal for treatment. MRI shows an abnormality in most patients.
Weight-bearing X-rays
Check heel alignment and bony causes, such as an abnormal bridge between two bones of the hindfoot (a coalition).
Treatment Without Surgery
Conservative care comes first unless something clearly needs removing. These steps are usually combined rather than tried one at a time.
Take Pressure Off the Nerve
- Ease off the standing, walking or exercise that brings symptoms on
- Ice for about 20 minutes at a time, with at least 40 minutes between sessions
- Anti-inflammatory medicine for a short course, if it is safe for you
Support the Foot
- Supportive shoes and custom orthotics, especially when flat feet stretch the nerve
- A brace or strapping that holds the foot neutral or slightly turned in, with some heel elevation, reduces tension on the nerve
- The research on arch supports alone is limited, so they work best as part of a wider plan
Physical Therapy and Nerve Gliding
- Strengthening and stretching for the foot and calf
- In a small randomized trial, adding nerve-gliding exercises improved sensation tests and Tinel's sign, though not pain
Medicine for Nerve Pain
- Nerve pain medicines such as gabapentin, or a low-dose tricyclic antidepressant, prescribed and monitored by your doctor
- These calm the burning and tingling; they do not relieve the pressure on the nerve
Injection
- A corticosteroid or local anesthetic injection near the nerve
- Most likely to help when inflammation or scar tissue is involved; relief is often temporary
- No controlled trials yet show how well it works for tarsal tunnel syndrome
How long before considering surgery?
There is no agreed timetable. One recent review suggests at least 12 to 24 months of conservative care when no specific cause has been found. A cyst or other lesion pressing on the nerve, weakness, or thinning of the foot muscles can justify surgery much sooner.
Tarsal Tunnel Release Surgery
In a tarsal tunnel release, also called decompression, the surgeon opens the flexor retinaculum through an incision of roughly 5 to 7 centimeters along the inner ankle, frees the tibial nerve, follows its branches into the arch, and removes anything pressing on it, such as a cyst or a cluster of enlarged veins. It is usually done as a day procedure.
Results tend to be better when
- A clear cause, such as a cyst or a bony coalition, is found and removed
- Symptoms have been present for a shorter time, ideally under a year
- It is the first operation on that nerve
Results tend to be less predictable when
- Symptoms have been present for many years
- No specific cause is found
- Diabetes or obesity is present, or it is a repeat operation
Honest numbers matter here. Published success rates range from 44% to 96%, and outcomes are generally less predictable than for carpal tunnel release in the wrist. In a series of 81 patients, those with excellent results had lived with symptoms for an average of about 2 years before surgery, compared with more than 6 years in those with poor results. True recurrence is uncommon, reported at under 5%, but repeat surgery has significantly worse results than a first release.
Possible complications include wound healing problems, infection, a tender scar, numbness, and symptoms that do not improve or occasionally worsen. Rarely, a chronic pain condition called complex regional pain syndrome can develop.
Recovery After Tarsal Tunnel Surgery
A typical plan after an open release. Your surgeon's instructions take priority where they differ.
| When | What usually happens |
|---|---|
| Week 1 | Cast or splint, no weight on the foot, foot raised as much as possible |
| Weeks 1 to 3 | Walking boot for about two more weeks |
| Week 2 | Stitches out |
| Weeks 2 to 6 | Back into a supportive lace-up shoe if healing is on track |
| Weeks 4 to 6 | Back to work: about 4 weeks for desk jobs, about 6 for physical jobs |
| Driving | Once you can do an emergency stop in a normal shoe; often 6 to 9 weeks after right-sided surgery |
| Weeks 8 to 16 | Return to sport can be considered |
| Months 6 to 12+ | Nerve symptoms keep improving; healing is considered complete at about a year |
The nerve is the slow part
The wound heals in weeks; the nerve takes months. In the 81-patient series, scores barely moved for the first six months and kept improving up to 18 months. Burning or tingling that is still there at six weeks is expected, not a sign that the operation has failed. Steady improvement over the following months is what to watch for. For more on getting back behind the wheel, see driving after foot surgery.
Sharp heel pain with your first steps in the morning? That pattern points to the fascia, not the nerve. Plantar Fasciitis Healing Timeline →
Burning in the ball of the foot, between two toes? Morton's Neuroma Treatment →
Having an injection? What to expect in the hours and days afterward. Cortisone Shot in the Foot →
Flat feet part of the picture? Flat Feet Treatment →
Choosing arch support? Custom Orthotics vs Store Insoles →
Frequently Asked Questions
What does tarsal tunnel syndrome feel like?
Most people describe burning, tingling, pins and needles, electric shocks or numbness along the inner ankle and the sole of the foot. It can spread into the heel, arch, toes and sometimes up the calf. Symptoms usually build with standing and walking, are worse later in the day, and ease with rest and putting the foot up, although they can also be noticeable at night. About half of patients describe a cold feeling in the foot, and it usually affects one foot rather than both.
How is tarsal tunnel syndrome different from plantar fasciitis?
Plantar fasciitis is a mechanical heel pain that is worst with the first steps in the morning or after sitting and eases as you keep walking. Tarsal tunnel syndrome is nerve pain: burning, tingling or numbness that spreads along the sole and tends to build the longer you are on your feet, sometimes lingering at rest. Heel and arch pain that has lasted more than six months without behaving like plantar fasciitis is a strong reason to consider a nerve. The two are easily confused; in one surgical series, almost 94% of patients had previously been diagnosed with plantar fasciitis.
Can tarsal tunnel syndrome go away on its own?
Sometimes. When the nerve is irritated by something that can settle, such as an inflamed tendon, a recent sprain or a flat foot that gets proper support, symptoms can improve with conservative care. When something is pressing on the nerve, such as a cyst or a cluster of enlarged veins, it is less likely to resolve without treatment of the cause. Research on non-surgical care is limited, so the usual approach is a structured trial of treatment with regular review.
Does a steroid injection help tarsal tunnel syndrome?
It can, mainly when inflammation or scar tissue around the nerve is part of the problem. Relief is often temporary, and there are no controlled trials showing how well injections work for tarsal tunnel syndrome. An injection is best seen as one step in a plan that also addresses footwear, foot support and activity, not a cure on its own.
How long is recovery after tarsal tunnel surgery?
A typical plan after an open tarsal tunnel release is about a week in a cast or splint without putting weight on the foot, then around two weeks in a walking boot, stitches out at about two weeks, and a return to a lace-up shoe between two and six weeks. Desk work often resumes at about four weeks and physical work at about six. Sport is usually considered between eight and sixteen weeks. The nerve recovers slowly: improvement commonly continues for up to a year, and some patients keep improving for 18 months.
How soon can I drive after tarsal tunnel surgery?
Only once you are out of the cast or boot and can perform an emergency stop safely in a normal shoe, and after checking with your insurer. After right foot or ankle surgery, around 6 to 9 weeks is often recommended. If the operated foot is the left and you drive an automatic, your surgeon may clear you sooner, once you are off strong pain medicine and can get in and out of the car safely. Never drive in a cast or boot on the right foot.
Can tarsal tunnel syndrome come back after surgery?
True recurrence is uncommon, reported at under 5%. More often, symptoms improve only partly, particularly when they had been present for years before surgery, when no specific cause was found, or when diabetes or obesity is present. Repeat surgery has significantly worse results than a first release, so persistent symptoms deserve a careful reassessment, including a check for a second source such as neuropathy or a back problem, before any further operation.
Sources and further reading
- ACFAS FootHealthFacts: Tarsal tunnel syndrome
- Cleveland Clinic: Tarsal tunnel syndrome
- MSD Manual Professional Edition: Tarsal tunnel syndrome (2025)
- Wye Valley NHS Trust: Tarsal tunnel decompression, patient information
- American Family Physician: Heel pain, diagnosis and management (2018)
- Fortier LM et al. An update on posterior tarsal tunnel syndrome. Orthopedic Reviews (2022)
- Vij N et al. Conservative versus surgical treatment of tarsal tunnel syndrome: a systematic review. Orthopedic Reviews (2022)
- Iborra A et al. Results of ultrasound-guided release of tarsal tunnel syndrome, 81 cases. J Orthop Surg Res (2020)
- Yoshida H et al. Tarsal tunnel syndrome: a clinical review. J Nippon Med Sch (2025)
General patient education. Your examination and individual treatment instructions take priority.
See a Podiatrist Near You
ASG Foot & Ankle has offices in Homewood, South Chicago Heights and Mokena. Our board-certified podiatrists accept most insurance. Find the office closest to you:
Burning or Tingling in Your Sole?
Nerve pain in the foot has several possible sources, and the right treatment depends on which one you have. Our podiatrists can examine the foot and the nerve at the inner ankle, arrange nerve testing or imaging when it is needed, and build a plan that starts with the simplest effective step.