Tarsal Tunnel Syndrome: Causes, Symptoms, and Conservative Treatment Options

Reviewed by the Physiotherapy Team at Waterloo Sports Medicine Centre

Do you experience burning, tingling, or numbness in your foot, especially around the inside of your ankle or the bottom of your foot? These symptoms may be caused by tarsal tunnel syndrome, a condition involving irritation or compression of the tibial nerve as it travels through the ankle. While foot nerve pain can be frustrating, many people improve with conservative treatment, including physiotherapy, activity modification, and addressing contributing factors. 

What Is Tarsal Tunnel Syndrome? 

Tarsal tunnel syndrome (TTS) occurs when the tibial nerve becomes compressed or irritated as it passes through a narrow space on the inside of the ankle called the tarsal tunnel. 

The tarsal tunnel is formed by the ankle bones and a strong band of connective tissue called the flexor retinaculum. Through this space pass the tibial nerve, arteries, veins, and tendons that supply and support the foot 

When pressure increases within the tunnel, the tibial nerve may become irritated, leading to pain, numbness, or tingling in areas supplied by the nerve. 

What Causes Tarsal Tunnel Syndrome? 

Tarsal tunnel syndrome can develop when something increases pressure around the tibial nerve. Common contributing factors include: 

• Ankle sprains or previous injuries 

• Flat feet or excessive foot pronation 

• Foot or ankle swelling 

• Ganglion cysts or other space-occupying masses 

• Diabetes or conditions affecting nerve health 

• Repetitive impact activities such as running or prolonged standing 

• Poor foot biomechanics that increase stress around the ankle

In many cases, multiple factors contribute rather than one single cause. 

Common Symptoms 

Symptoms may include: 

• Burning pain in the bottom of the foot 

• Tingling or “pins and needles” sensations 

• Numbness in the sole of the foot or toes 

• Electric shock-like pain 

• Foot discomfort that worsens with prolonged standing or walking 

• Symptoms that may worsen at night 

• Weakness of the foot muscles in more advanced cases 

Symptoms may be felt in different areas depending on which branches of the tibial nerve are affected. 

Who Is at Risk? 

You may have a higher risk of developing tarsal tunnel syndrome if you: 

• Participate in high-impact activities such as running 

• Spend long periods standing or walking 

• Have flat feet or altered foot mechanics 

• Have a history of ankle injuries 

• Have medical conditions affecting nerve health 

• Experience repeated swelling around the ankle 

  
  

How Can Physiotherapy Help? 

Physiotherapy focuses on reducing irritation around the nerve, improving foot and ankle mechanics, and addressing contributing factors. Your physiotherapist may recommend: 

Activity Modification 

Adjusting aggravating activities, footwear, or training volume can help reduce stress on the tibial nerve while symptoms settle. 

Foot and Ankle Strengthening 

Strengthening the muscles that support the foot and ankle may improve stability and reduce excessive strain during walking, running, and sport. 

Exercises may focus on: 

• Foot intrinsic muscles 

• Calf muscles 

• Ankle stabilizers 

• Hip and lower limb muscles that influence movement patterns 

  
  

Mobility and Stretching Exercises 

Improving mobility of the calf, ankle, and surrounding tissues may help optimize movement and reduce stress through the tarsal tunnel. 

Nerve Mobility Exercises 

Specific nerve gliding exercises may be used to encourage healthy movement of the tibial nerve and reduce sensitivity when appropriate. 

Footwear and Orthotic Recommendations 

Supportive footwear or orthotic devices may be recommended for individuals whose foot mechanics contribute to increased stress around the nerve. 

Manual Therapy 

Hands-on techniques may help improve mobility of the ankle, foot, and surrounding soft tissues as part of a comprehensive rehabilitation program. 

Recovery and Healing Time 

Recovery depends on the cause, severity, and duration of symptoms. 

• Mild cases: Symptoms may improve over several weeks with activity modification and physiotherapy. 

• Moderate cases: Recovery may take several months, particularly when symptoms have been present for a longer period. 

• Persistent cases: Further medical assessment may be required if symptoms do not improve with conservative care. 

Addressing contributing factors early can improve the likelihood of successful recovery. 

When Should You See a Physiotherapist? 

Consider booking an assessment if you have: 

• Persistent burning or tingling in your foot 

• Numbness in the sole of your foot or toes 

• Foot pain that worsens with standing or walking 

• Symptoms affecting exercise, work, or daily activities 

• Foot symptoms that are not improving with rest 

  
  

At Waterloo Sports Medicine Centre, our physiotherapists can assess your foot and ankle symptoms, identify factors contributing to nerve irritation, and develop a personalized treatment plan to help you return to comfortable movement.