Tarsal tunnel syndrome: What it is and how to treat it

Suffer pins and needles or a burning pain along the inside of your foot? It could be tarsal tunnel, says physio Lindel Coulter. Here she explains causes, symptoms, treatment and prevention

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Tarsal tunnel is a condition that occurs in the foot due to entrapment of the tibial nerve as it passes through a tunnel on the inside of the ankle. The tunnel is formed by bones and ligaments and covered in a thick connective tissue (retinaculum). 


The tibial nerve is an extension of the sciatic nerve which runs down the back of the thigh. The tibial branch of the nerve runs along the inside of the shin and then splits as it enters the foot. It provides sensation and movement to the muscles along the bottom and inside part of the foot.

What causes tarsal tunnel syndrome?

The more prominent causes we see are:

  • Trauma to the ankle (like ankle sprains or fractures).
  • Overuse associated with excessive foot pronation due to poor foot mechanics.
  • Overusing the muscles that flex the toes.

What are the symptoms of tarsal tunnel syndrome?

The main symptoms that people will experience are pain and burning, in particular along the bottom and inner portion of the foot.

These are some of the associated symptoms to look out for:

  • Pins and needles along the inside portion of your foot (this may extend into the toes).
  • Pain that is exacerbated by exercise and relieved by rest.
  • Some weakness in the muscles that flex the toes.
  • A burning sensation in the foot that may disrupt sleep.

How can you treat tarsal tunnel syndrome?

Physiotherapy can assist in the management of tarsal tunnel syndrome. People will often see the start of positive changes in the first few weeks. The recovery timeline will differ between people depending on age, muscular conditioning, lower-limb functional weaknesses and compliance to your rehabilitation.

Physiotherapy will aim to:

  • Empower you by educating you on your condition.
  • Reduce your foot and ankle pain.
  • Provide an onward podiatry referral if required.
  • Improve the control around your hips and knees.
  • Improve your foot mechanics and control.
  • Asses your walking and sporting technique and address any functional weaknesses found.
  • Guide you into a return to sport programme.

In a few cases of severe pain, onward referral may be needed to look at alternative treatment options.

How can you prevent tarsal tunnel syndrome?

There are a few things that may be able to assist in the prevention of tarsal tunnel:

  • Correct footwear that supports and suits your foot.
  • Avoiding a sudden increase in exercise load (especially high impact).
  • Adequate muscular conditioning to complement cardiovascular training.
  • Ensure that any ankle trauma is correctly treated, and rehabilitated.

If these symptoms sound familiar, see your physiotherapist to get an assessment done sooner rather than later.


If you have any concerns at all, like with any health issue, seek medical advice from a qualified medical practitioner, whether that’s a doctor or physiotherapist.