Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome (TTS) is an entrapment of the posterior tibial nerve or one of its branches within the tarsal canal by the flexor retinaculum, the fibro-osseous tunnels, or the deep fascia. There are many causes of this syndrome but the most common are as follows; fallen arches resulting from over-pronation of subtalar joint, tumor or mass in the tarsal tunnel, varicose veins, ganglion cysts, edema and arthritis.

Symptoms usually include pain in the heel and can mimic plantar fasciitis. Pain usually is described as shooting in nature and can often cause numbness on the inside of the foot. Pain is aggravated with activity and relieved by rest. In severe cases muscle weakness and atrophy can be encountered.



Diagnosis is made clinically but imaging can help with diagnosis. Ultrasounds and MRI are very sensitive and specific in the diagnosis and can also help identify the cause. Treatment also depends on the cause. Nerve conduction studies are often ordered as well.

Conservative treatment is always tried first which includes bracing, orthotics, RICE, NSAIDs and steroid injections in the tarsal tunnel. In severe cases or when conservative treatment fails, surgical decompression of the PT nerve is performed. Recurrence rates are low but it is always a possibility. Post operative course is predictable and simple.


Patients usually go home the day of surgery in a CAM walker. If you have these symptom