Tarsal tunnel syndrome is a nerve compression problem around the inner side of the ankle. In my practice, I usually explain it as pressure on the tibial nerve as it passes through a narrow tunnel near the ankle bone. When that nerve is irritated, patients may feel burning, tingling, numbness, or electric-shock-like pain in the sole of the foot and toes.
This condition is often missed at first because many patients assume the pain is only from standing too long, walking too much, or wearing poor footwear. Those factors can worsen symptoms, but persistent nerve-type pain should not be dismissed. In Bangladesh, I often see patients delay care until the symptoms start affecting work, prayer, sleep, or walking confidence.
What Tarsal Tunnel Syndrome Means
The tarsal tunnel is a narrow space on the inside of the ankle. The tibial nerve, tendons, blood vessels, and surrounding tissues pass through it. If swelling, a cyst, flat foot strain, a previous injury, or another local problem reduces that space, the nerve can become compressed.
That compression can cause:
- burning pain in the inner ankle or sole
- tingling or pins-and-needles sensation
- numbness in the foot or toes
- weakness in more advanced cases
This is different from plantar fasciitis, which is another common cause of foot pain. Plantar fasciitis usually causes heel pain from a soft-tissue strain, while tarsal tunnel syndrome is a nerve problem. The two can overlap, which is one reason a careful examination matters.
Symptoms I Look For
The symptoms vary from person to person, but several patterns are common.
Common symptom pattern
- burning or aching on the inside of the ankle
- pain spreading into the arch or sole
- numbness or tingling in the bottom of the foot
- symptoms that worsen after standing or walking for long periods
- discomfort that sometimes becomes more noticeable at night
When I evaluate patients with this problem, I pay close attention to whether the pain feels nerve-like. Patients often describe it as burning, shooting, buzzing, or electrical. That description is often more useful than the exact location alone.
Why It Happens
Tarsal tunnel syndrome is not caused by one single disease. It happens when something increases pressure on the tibial nerve.
Common causes include:
- swelling after an ankle sprain, fracture, or other injury
- flat feet or a high-arch foot shape
- ganglion cysts or other masses
- varicose veins or local soft-tissue swelling
- arthritis or joint inflammation nearby
- scar tissue after injury or surgery
- systemic problems such as diabetes, hypothyroidism, or inflammatory disease
In Bangladesh, prolonged standing, repetitive strain, and unsupportive footwear may aggravate symptoms once the nerve is already under pressure. That does not mean the footwear is the only cause, but it can make the condition more noticeable.
Conditions That Can Look Similar
Not every burning or numb foot is tarsal tunnel syndrome. I always think about other possibilities before settling on the diagnosis.
Common look-alikes
- plantar fasciitis
- diabetic neuropathy
- lumbar nerve irritation from the lower back
- Achilles or tendon problems
- arthritis-related pain
- circulation problems
- stress injury or fracture
This is why self-diagnosis is unreliable. A patient with diabetes, previous ankle injury, back pain, or swelling around the foot may have more than one issue contributing to the symptoms.
How I Evaluate It
I start with the history. I want to know where the pain begins, whether it burns or tingles, whether numbness is present, whether the symptoms are one-sided or both-sided, and whether there was a recent sprain, fracture, or change in activity.
The physical examination is important as well. I assess:
- foot posture and arch shape
- tenderness along the nerve pathway
- sensation in the sole and toes
- ankle movement
- muscle strength
- whether tapping over the nerve reproduces symptoms
Tests that may help
Depending on the case, I may advise:
- X-ray if bone alignment or arthritis is suspected
- ultrasound or MRI if a cyst, swelling, or soft-tissue crowding is suspected
- nerve conduction studies or EMG in selected patients
These tests do not replace the clinical story. They support the diagnosis when the symptoms and examination fit together.
Treatment Without Surgery
Many patients improve without surgery, especially when the diagnosis is made early. The main goal is to reduce pressure on the nerve and correct the factor that is irritating it.
Treatment may include:
- rest and temporary activity modification
- ice and elevation if swelling is present
- anti-inflammatory medicine when appropriate
- physical therapy
- arch support or orthotics
- footwear changes
- short-term bracing in selected cases
I usually explain to patients that tablets alone rarely fix a mechanical nerve compression problem. If the foot mechanics are contributing, the plan should address that directly.
Footwear and support
Supportive shoes can matter. Soft, loose slippers may feel comfortable, but they may not give enough stability for a foot that is already under strain. Some patients do better with a structured shoe or an insole that supports the arch and reduces repeated irritation.
