What does tarsal tunnel syndrome feel like?

Tarsal tunnel syndrome typically produces burning, tingling, or electric pain along the inner ankle and into the sole of the foot or toes. Many patients also experience numbness in a stocking-like distribution. Symptoms worsen after prolonged standing or walking and improve with rest. Tapping over the inside of the ankle reproduces the shooting pain — a clinical finding called Tinel's sign.

Is tarsal tunnel syndrome the same as plantar fasciitis?

No. Plantar fasciitis causes heel pain from inflammation of connective tissue and does not produce neurological symptoms like tingling, burning, or numbness. Tarsal tunnel syndrome produces those neurological symptoms because it involves compression of the tibial nerve. The two conditions can coexist, but they require different treatments. Misdiagnosis of tarsal tunnel syndrome as plantar fasciitis is common and leads to prolonged ineffective care.

Can tarsal tunnel syndrome occur alongside Morton's neuroma?

Yes. Some patients have nerve compression at both the tarsal tunnel (tibial nerve at the ankle) and the metatarsal interspaces (interdigital nerves in the forefoot). This is known as double crush syndrome. When both conditions are present, treating only one entrapment site may produce incomplete relief. A comprehensive nerve evaluation is essential to identify all entrapment points before treatment.

Tarsal Tunnel Syndrome | Foot & Ankle Nerve Entrapment - Dr. Peter Bregman | Morton's Neuroma Decompression Specialist

Tarsal tunnel syndrome is a nerve entrapment condition affecting the tibial nerve as it passes through the tarsal tunnel on the inner side of the ankle. It is the foot and ankle equivalent of carpal tunnel syndrome in the wrist — and it is frequently misdiagnosed or confused with plantar fasciitis and other heel pain conditions.
What Is Tarsal Tunnel Syndrome?
The tarsal tunnel is a narrow passage on the medial (inner) side of the ankle, formed by bone on one side and the flexor retinaculum — a thick band of connective tissue — on the other. Through this tunnel run the tibial nerve, the posterior tibial artery and vein, and several tendons. When the space within this tunnel becomes compromised — due to swelling, a space-occupying lesion, scar tissue, or structural abnormality — the tibial nerve becomes compressed, producing the characteristic symptoms of tarsal tunnel syndrome (TTS).
Symptoms of Tarsal Tunnel Syndrome
Tarsal tunnel syndrome produces a distinctive pattern of symptoms that distinguishes it from other foot pain conditions:

Burning, tingling, or electric pain along the inner ankle, heel, or bottom of the foot
Numbness in the sole of the foot or toes, often in a stocking-like distribution
Symptoms that worsen with standing, walking, or prolonged activity and improve with rest
Night pain or pain at rest in moderate-to-severe cases
Positive Tinel’s sign: tapping over the tarsal tunnel reproduces tingling or shooting pain into the foot
Weakness in toe flexion in advanced cases (the intrinsic muscles of the foot are innervated by the tibial nerve branches)

Symptoms may be diffuse (affecting the entire bottom of the foot) or localized (affecting only the heel or only the toes) depending on which branch of the tibial nerve is most compressed.
How Is Tarsal Tunnel Syndrome Different from Morton’s Neuroma?
Both conditions involve nerve entrapment in the foot, but the location and mechanism differ. Morton’s neuroma involves the interdigital nerves between the metatarsal heads in the ball of the foot, typically causing pain and numbness in the toes and forefoot. Tarsal tunnel syndrome involves the tibial nerve at the ankle, producing pain along the inner ankle, heel, and sole. Some patients have both conditions simultaneously — and distinguishing them is critical before any surgical decision is made. Selective nerve blocks at each anatomical site help confirm which nerve is responsible for a patient’s symptoms.
Causes and Risk Factors
Tarsal tunnel syndrome can result from several underlying causes:

Structural: Flat feet (overpronation) change the mechanics of the ankle and can chronically stretch and compress the tibial nerve. Bone spurs, ganglion cysts, lipomas, or varicose veins within the tarsal tunnel can reduce available space.
Inflammatory: Rheumatoid arthritis and other inflammatory conditions cause synovial swelling that can compress the nerve within the tunnel.
Traumatic: Ankle sprains, fractures, or repetitive ankle injuries can lead to scar tissue formation within the tarsal tunnel.
Idiopathic: In some cases, no clear structural cause is identified — the nerve is simply entrapped by the retinaculum without an obvious space-occupying lesion.

Diagnosis
Tarsal tunnel syndrome is a clinical diagnosis, meaning a thorough physical examination by an experienced physician is the most important diagnostic tool. Key elements include:

Tinel’s test at the tarsal tunnel (tapping the nerve to reproduce symptoms)
Nerve conduction studies (NCS) and electromyography (EMG) to objectively measure nerve function — though these tests can be falsely negative in up to 30% of confirmed cases
MRI to identify space-occupying lesions, scar tissue, or structural abnormalities within the tunnel
Diagnostic nerve block of the tibial nerve at the tarsal tunnel to confirm the diagnosis — temporary relief after injection confirms the nerve as the pain source

Misdiagnosis is common. Tarsal tunnel syndrome is frequently confused with plantar fasciitis (which produces heel pain but no neurological symptoms), peripheral neuropathy (which produces bilateral symmetric symptoms rather than unilateral nerve-distribution pain), or lumbar radiculopathy (which originates in the spine).
Treatment Options
Conservative Care
Initial treatment focuses on reducing nerve compression without surgery. Options include orthotics to correct overpronation, anti-inflammatory medications, corticosteroid injections into the tarsal tunnel, physical therapy to reduce inflammation and improve ankle mechanics, and activity modification to limit aggravating positions. Conservative care resolves symptoms in a meaningful proportion of mild-to-moderate cases, particularly when a clear precipitating factor (such as flat foot mechanics) can be addressed.
Surgical Release (Tarsal Tunnel Release)
When conservative treatment fails to provide lasting relief, surgical decompression of the tarsal tunnel is performed. The procedure involves releasing the flexor retinaculum under magnification to relieve pressure on the tibial nerve. If a space-occupying lesion is identified, it is removed at the time of surgery. Like Morton’s neuroma decompression, tarsal tunnel release is a nerve-preserving procedure — the nerve is released, not removed. Results are best when the diagnosis is precise, the nerve has not been damaged irreversibly, and surgery is not delayed too long after symptom onset.
How This Relates to Morton’s Neuroma
Patients with Morton’s neuroma sometimes also have tarsal tunnel syndrome — a condition called “double crush syndrome,” where the same nerve (or nerve network) is compressed at more than one point along its course. In these cases, treating only one entrapment site may produce incomplete relief. A thorough specialist evaluation that examines the entire foot and ankle nerve system is essential before any treatment decision is made.
If you have been treated for Morton’s neuroma without full relief, or if your pain includes significant heel, arch, or ankle involvement alongside forefoot pain, tarsal tunnel syndrome should be considered as a contributing or separate diagnosis. Contact our office to schedule a comprehensive nerve evaluation.