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Foot Health / Problems
Tarsal Tunnel Syndrome

Your tarsal bones are the short bones that form a bridge between your ankle and your metatarsal bones. Your tarsal tunnel is a space located just below the bony prominence on the inside of your ankle (also known as your medial malleolus), and it is made up of bone on the inside and your flexor retinaculum—a band of connective tissue—on the outside. Several structures pass through your tarsal tunnel, including tendons, blood vessels, and your tibial nerve. Compression of any of these tarsal tunnel structures can cause foot problems.

Condition Information

Tarsal tunnel syndrome, also known as tibial nerve dysfunction or neuralgia, occurs when your tibial nerve—the nerve that supplies movement and sensation to your foot muscles—becomes entrapped or compressed within your tarsal tunnel. The parts of your foot affected by this compression neuropathy depend on the area of entrapment. Any problem or condition that causes inflammation and swelling in your tarsal tunnel can cause tarsal tunnel syndrome, as increased pressure causes compression of your tibial nerve and sensations such as numbness, tingling, and cramping.

Causes and Symptoms

The underlying cause of tarsal tunnel syndrome is often difficult to determine. But anything that increases pressure in your tarsal tunnel can cause this health problem, including benign tumors or cysts, tendon sheath inflammation, bone spurs, nerve ganglions, and varicose veins. Direct trauma is another possible cause of tarsal tunnel syndrome.

Excessive foot pronation (the inward rolling of your ankle) may compress your tibial nerve, leading to tarsal tunnel syndrome. Most conventional footwear holds your foot in a position in which excessive pronation is inevitable. You may experience symptoms bilaterally (i.e., on both sides of your body) if your tarsal tunnel syndrome is caused by inappropriate footwear.

Most conventional footwear holds (and essentially immobilizes) your big toe in a bunion configuration (i.e., big toe extended and pointing toward your second toe). In this configuration, your abductor hallucis muscle pulls on your flexor retinaculum—a band of fibrous tissue that overlies your tarsal tunnel—which cinches down on the structures passing through this tunnel, including your tibial nerve.

Some of the most common signs and symptoms associated with tarsal tunnel syndrome include:

  • Foot, ankle, and toe muscle weakness
  • Foot pain
  • Burning, numbness, or other unusual sensations in your foot


Swapping your conventional shoes with anatomically appropriate models may be one of the most effective treatment (and prevention) strategies for this health problem. Beneficial shoes are completely flat (no heel elevation, no toe spring), lightweight, flexible, and feature a toe box that’s widest at the ends of the toes. Realigning your toes using Correct Toes and foot-healthy footwear will help minimize or eliminate excessive foot pronation and reduce the tension of your flexor retinaculum on your tibial nerve and other structures passing through your tarsal tunnel. Also helpful is regularly stretching your big toe away from your second toe.

Other beneficial conservative treatment strategies include cold therapy, rest, physical therapy, and natural anti-inflammatory agents. Always follow your doctor’s treatment recommendations for this health problem.


In his 18 years as a podiatrist, Dr. Ray McClanahan has learned that most foot problems can be corr...