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Tarsal Tunnel Syndrome Foot or ankle pain accompanied by numbness or tingling may signal nerve compression near the ankle. Tarsal tunnel syndrome occurs when the posterior tibial nerve is compressed within the tarsal tunnel—a narrow passageway located along the inner ankle near the medial malleolus. This small space contains the tibial nerve, arteries, veins, tendons, and surrounding soft tissue, making it particularly susceptible to irritation from swelling, overuse, or structural conditions such as flat feet, tarsal coalition, or bone spurs.
At New Orleans Podiatry, board-certified podiatric surgeon Dr. Edward Lang approaches each case with precision and an unwavering focus on the individual. Through a detailed physical examination, symptom analysis, and—when indicated—advanced diagnostics such as nerve-conduction studies or MRI imaging, Dr. Lang designs a treatment plan tailored specifically to your condition. Our concierge-style care allows patients to begin treatment promptly—often preventing lasting nerve damage—and return to walking with comfort and confidence
Targets tibial nerve entrapment to reduce burning sensation, sharp pain, and numbness.
Conservative and surgical decompression options tailored to the underlying cause.
Prevents further injury and permanent nerve damage.
Comprehensive aftercare promotes a smooth recovery.
Tarsal tunnel syndrome is a condition caused by compression of the posterior tibial nerve, which runs through the tarsal tunnel - a narrow space located on the inside of the ankle, adjacent to the ankle bones.
This tunnel is surrounded by bone and soft tissue and contains multiple vital structures, including arteries, veins, tendons, and nerves.
The posterior tibial nerve, a branch of the sciatic nerve, travels down the leg along the shinbone and enters the foot through this confined space. When this nerve becomes compressed or irritated, it can lead to burning, tingling, numbness, or shooting pain in the ankle, foot, or toes.
This condition is frequently misdiagnosed as plantar fasciitis due to overlapping symptoms, especially heel and arch pain.
However, unlike plantar fasciitis, tarsal tunnel syndrome involves nerve compression and may present with neurological signs like tingling or numbness.
If left untreated, prolonged nerve compression can lead to permanent nerve damage and chronic pain.
Common tarsal tunnel syndrome symptoms include:
Treatment for tarsal tunnel syndrome depends on the severity and underlying cause of the nerve compression. At New Orleans Podiatry, we begin with the most effective non-surgical options whenever possible, and progress to advanced interventions if needed.
If conservative treatments fail to relieve symptoms, surgical decompression of the tarsal tunnel may be recommended. This outpatient procedure involves making an incision along the inside of the ankle to access the tarsal tunnel. The surgeon carefully releases the flexor retinaculum—the tight band of tissue forming the roof of the tunnel—to relieve pressure on the posterior tibial nerve and its branches.
In some cases, additional space is created by addressing nearby structures contributing to the compression, such as swollen tendons, cysts, or scar tissue. The goal of surgery is to restore normal nerve function, reduce pain, and prevent long-term nerve damage.
At New Orleans Podiatry, we tailor every treatment plan to your unique anatomy, activity level, and lifestyle—ensuring you get the most effective care with the least disruption to your daily life.
On surgery day, you’ll receive anesthesia for comfort. Dr. Lang makes a small incision along the medial ankle to expose the flexor retinaculum, or the roof of the tarsal tunnel. The tissue is released to create more space, easing pressure on the tibial nerve and its branches. If present, soft tissue swelling, a ganglion cyst, or other space-occupying lesions are addressed.
Once the tarsal tunnel is released, the incision is closed, and the foot is protected in a dressing or removable boot. Most patients go home the same day and begin a staged recovery plan to reduce swelling and restore mobility.
Tarsal tunnel decompression is most often performed to relieve the nerve compression caused by chronic tarsal tunnel syndrome, but it can also address several related issues. In many patients, tibial nerve dysfunction develops after scar tissue forms from ankle sprains, while others experience compression from structural problems such as flat feet or tarsal coalition. Growths like a ganglion cyst or bone spur, as well as soft tissue swelling related to systemic diseases or overuse injuries, can also narrow the tarsal tunnel and place pressure on the nerve.
By reducing this pressure and restoring normal space within the tunnel, decompression surgery helps alleviate symptoms and prevent further injury to the nerve.
Successful treatment for tarsal tunnel syndrome symptoms provides:
Less advanced cases of tarsal tunnel syndrome may respond well to conservative, non-surgical treatments such as custom orthotics, corticosteroid injections, and/or physical therapy. If tarsal tunnel syndrome symptoms persist, and you have confirmed tibial nerve entrapment, you may be a candidate for surgical decompression of the tarsal tunnel. Candidates often include those with posterior tibial nerve neuralgia, medial plantar nerve pain, or tibial nerve dysfunction that interferes with mobility.
Dr. Lang uses advanced diagnostic techniques such as nerve conduction studies or magnetic resonance imaging to get a clear picture of your condition and recommend the best treatment option for your needs. At your initial consultation, he will learn about your symptoms, recommend diagnostic methods as needed, and educate you about next steps, helping make informed choices about your care.
Most patients return home the same day, with a recovery period that includes rest, limited weight-bearing, and physical therapy to regain strength and flexibility. Outcomes are typically favorable when the procedure is performed early in the course of the condition.
Most patients transition from limited weight bearing to full walking over 4–6 weeks, with continued improvements in nerve function over several months. Stitches are usually removed around 2–3 weeks post-op, and light stretching or mobility exercises may be introduced shortly after. Wearing supportive footwear, following all activity restrictions, and keeping post-op appointments are essential for preventing setbacks and ensuring the best possible outcome.
Many patients experience pain relief and improved sensation within weeks. Nerve healing continues for several months, and final results can last for years when the underlying cause is addressed. In severe cases treated promptly, the procedure can prevent permanent nerve damage and restore near-normal muscle function. For many, this means walking longer distances without discomfort, sleeping through the night without burning sensations, and returning to work, hobbies, and exercise with renewed confidence and comfort.
With more than 30 years of expertise in podiatric medicine and foot and ankle surgery, Dr. Lang combines diagnostic precision with advanced surgical mastery. His comprehensive approach addresses the root cause of tarsal tunnel syndrome, safeguards the surrounding structures of the foot and ankle, and supports healing through every phase of recovery.
At New Orleans Podiatry, patients benefit from same-day appointments, direct access to Dr. Lang, and personalized recovery plans designed to restore mobility, relieve pain, and help you return to the active life you love..
Dr. Lang will use a detailed physical examination, discussion of your symptoms, and, when necessary, nerve conduction studies, ultrasound, or magnetic resonance imaging to confirm tibial nerve entrapment in the tarsal tunnel.
If tarsal tunnel syndrome is not treated, prolonged tibial nerve compression can lead to permanent nerve damage, reduced muscle function, and chronic foot and ankle pain. Early diagnosis and timely treatment, whether conservative care or surgical intervention, greatly improve outcomes and help prevent further injury.
Yes. Tarsal tunnel syndrome can often be managed with nonsurgical treatment in its early stages, especially when symptoms are mild. Options include custom orthotics to support flat feet, physical therapy to improve flexibility and strength, steroid injections or nonsteroidal anti-inflammatory drugs to reduce swelling, and activity modifications to relieve pressure on the posterior tibial nerve. When these approaches fail to resolve symptoms, tarsal tunnel release surgery may be recommended to prevent permanent nerve damage.
Yes. Untreated tibial nerve compression in the tarsal tunnel can cause permanent sensory and muscle function loss, which is why early diagnosis is important.
Plantar fasciitis affects the ligament on the bottom of the foot, while tarsal tunnel syndrome affects the tibial nerve inside the tarsal tunnel.
Most patients return to normal walking within a few weeks of surgery for tarsal tunnel syndrome, but complete nerve recovery can take several months.
Yes. Flat feet can strain the structures inside the tarsal tunnel, increasing the risk of tibial nerve entrapment.
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