If the bottom of your foot burns, tingles or goes numb, and it gets worse when you stand, walk or lie in bed at night, tarsal tunnel syndrome may be the cause. It happens when a nerve is squeezed in a narrow ankle channel, and it is often missed.
It is easy to confuse with plantar fasciitis, a pinched nerve in the back or neuropathy in both feet. Below: what tests can show, and treatment results in real numbers.
Tarsal tunnel syndrome is pressure on the tibial nerve in a narrow channel on the inside of the ankle. It typically causes burning, tingling, shooting pain or numbness in the sole, heel or toes that worsens with standing, walking or at night. Non-surgical care usually comes first. Surgery is considered if that fails, or sooner if a cyst is pressing on the nerve or foot muscles are weakening.
What is tarsal tunnel syndrome?
Doctors call it an entrapment neuropathy: nerve irritation from pressure at one spot. StatPearls describes it as the ankle's version of carpal tunnel syndrome, though much less common.
The tarsal tunnel and the tibial nerve
The tarsal tunnel is a firm channel behind the bony bump on the inner ankle. Through it run the posterior tibial nerve, an artery, a vein and three tendons. The nerve then branches to carry feeling from the sole and toes, so crowding or stretching in the tunnel squeezes it.
Who gets it
Women are about 3 times more likely than men to get it, and it most often starts between ages 40 and 60. A 2022 systematic review adds athletic participation as a risk factor.
Tarsal tunnel syndrome symptoms
- Burning, tingling or pins and needles in the sole
- Shooting or electric-shock pain on the inside of the ankle that can spread to the heel, arch, toes or calf
- Numbness on the bottom of the foot
- A feeling like walking on pebbles or sand
Why it flares with standing, walking or at night
Symptoms tend to worsen during or after activity and can become constant when severe. StatPearls notes pain often worsens at night, disrupting sleep. These tips on sleeping with nerve symptoms may help.
Later signs
Numbness may start intermittent, then turn constant. Weak or wasted foot muscles and clawed toes signal advanced compression. Untreated, it can lead to foot deformity and loss of toe movement or feeling.
Tarsal tunnel syndrome causes
| Category | Examples | What the evidence says |
|---|---|---|
| Injury | Ankle sprain, ankle or heel fracture, scar tissue | 17% to 43% of patients report past trauma |
| Something taking up space | Varicose veins (enlarged, twisted veins), ganglion cysts (fluid-filled lumps), lipomas, bone spurs, swollen tendons | Varicose veins found in about 20% of patients; nerve tumors are rare |
| Foot shape | Flat feet, overpronation (foot rolling inward) | Widely listed, but disputed (see below) |
| Health conditions | Diabetes, inflammatory arthritis, underactive thyroid, kidney failure or dialysis, obesity | Named in the 2022 systematic review and Iowa review |
| Activity | Running, sports, overuse | Often brought on by overuse |
Do flat feet cause tarsal tunnel syndrome?
Sources disagree: ACFAS, MedlinePlus, Cleveland Clinic and an NHS patient leaflet link flat feet to stretching and compressing the nerve. The 2024 Iowa review says a flat or pronated foot is not directly linked. Foot mechanics may contribute in some people, but flat feet alone don't mean you'll develop it.
When no cause is found
StatPearls and a 2021 EFORT Open Reviews paper say a cause is found in about 80% of cases, but two other reviews, including a 2025 clinical review, call unexplained cases the most common type.
Tarsal tunnel vs plantar fasciitis and other look-alikes
The short answer: tarsal tunnel syndrome is a nerve problem, causing burning, tingling or numbness in the sole that builds with standing, walking or at night. Plantar fasciitis is heel pain that is worst with your first steps in the morning.
| Condition | Typical feel and location | Clues that point toward it |
|---|---|---|
| Plantar fasciitis | Pain at the bottom of the heel | Worst with first steps in the morning or after rest, and after activity rather than during it |
| Polyneuropathy (for example, from diabetes) | Numbness, tingling or burning in both feet | Symmetric pattern; early cases are often misdiagnosed as tibial nerve problems |
| S1 radiculopathy (pinched nerve root in the lower back) | Shooting pain down the leg to the outer foot | Weaker ankle reflex, calf weakness |
| Baxter's nerve entrapment | Pain on the inner heel | Easily mistaken for plantar fasciitis |
Not sure which pattern fits? Compare with this guide to foot pain by location. If both feet are affected, see these symptoms of neuropathy in the feet and what triggers neuropathy in the feet.
Tarsal tunnel syndrome tests: how it's diagnosed
There is no gold-standard test. A 2026 systematic review of 82 studies and 4,213 patients found diagnosis and test accuracy varied widely. Clinicians combine your history, exam and tests.
- Tinel's sign: tapping behind the inner ankle bone to see if it triggers tingling. It picks up only 25% to 75% of cases, so a negative result doesn't rule it out.
- Dorsiflexion-eversion test: the ankle is held turned out and pulled up, toes bent back, for 5 to 10 seconds. StatPearls reports it is positive in about 82% of patients.
- Nerve conduction studies and EMG: measure how signals travel along the nerve and into muscles. They help rule out polyneuropathy or a back problem but are often normal in mild or slow-developing cases.
- Ultrasound and MRI: can show cysts, varicose veins and tendon problems and rule out other causes, but have limited accuracy for the syndrome itself, and MRI can show apparent nerve compression that isn't causing symptoms.
- Diagnostic injection: numbing medicine that briefly eases symptoms supports the diagnosis.
Tarsal tunnel syndrome treatment
A 2024 scoping review rated the treatment evidence as low quality, mostly small observational studies. Non-surgical care comes first unless there is muscle wasting or motor weakness or a clear compressing lesion such as a ganglion cyst.
| Step | Option | Evidence for this condition |
|---|---|---|
| 1 | Rest, ice and cutting back on triggering activity | Limited |
| 1 | Supportive shoes, custom orthotics or bracing; medial heel wedge | Limited |
| 1 | Physical therapy; over-the-counter anti-inflammatories | Limited |
| 2 | Prescription nerve-pain medicines such as gabapentin, pregabalin or tricyclic antidepressants | Limited |
| 2 | Corticosteroid injection into the tunnel | Limited; also helps confirm the diagnosis |
| 3 | Surgical release (decompression) to take pressure off the nerve | Limited; reported success 44% to 96% |
Shoes, orthotics and physical therapy
A medial heel wedge tilts the heel inward, reducing pull on the nerve. This shoe buying guide for sensitive feet covers fit and support. A physical therapist can tailor a program; these starter exercises for nerve symptoms are a reference, but stop any movement that flares symptoms.
Ask a pharmacist or doctor whether anti-inflammatory medicines are safe for you. No supplement has been shown in controlled trials to treat this condition, so supplements are not a substitute for diagnosis and treatment. Large doses of vitamin B6 can themselves cause numbness.
Tarsal tunnel syndrome surgery
Surgery is considered when non-surgical care fails or a clear cause, such as a cyst, is found; symptoms caused by a growth generally respond well. Options include open, endoscopic and ultrasound-guided release. Complications, such as wound-healing problems, infection or a thick scar, occur in 6.2% to 12% of cases, and some people have ongoing pain or a return of symptoms. Results are generally less favorable than after carpal tunnel surgery.
If you have diabetes, tarsal tunnel release is different from "nerve decompression" offered for diabetic neuropathy, which a 2018 structured review found too little evidence to recommend.
What results realistically look like
- Non-surgical care: in 76 feet followed for 5 years, 65% had satisfactory results with medical treatment. That rose to 78% once 16 feet that hadn't improved after 6 months had surgery.
- Across 32 studies: 75.3% of results were good or excellent, 24.7% fair or poor.
- Better odds: younger age, a clear cause, a positive Tinel's sign and a short symptom history. In 81 patients who had ultrasound-guided release, excellent results followed 22.6 months of symptoms on average, versus 79.2 months for poor results.
- Poorer odds: both feet affected, no clear cause, long-standing symptoms, neuropathy or coexisting plantar fasciitis.
When to see a doctor
Call 911 or go to the emergency room
- Sudden numbness or weakness in the face, arm or leg, especially on one side, or sudden trouble speaking or seeing: possible stroke.
- Numbness in the groin, buttocks or inner thighs (the saddle area), or new trouble controlling your bladder or bowels. This can signal cauda equina syndrome, a spinal emergency.
- A foot or leg that suddenly turns cold, pale or blue, with new pain, numbness, tingling or weakness, or a weak or missing pulse. A blood clot may be blocking an artery.
- Weakness or tingling that starts in both feet and spreads up the legs over hours or days, especially with trouble walking or climbing stairs. This can be Guillain-Barré syndrome.
- After an ankle or leg injury, severe pain much worse than expected that doesn't ease with pain medicine or raising the leg, with swelling, numbness or tingling. This can be compartment syndrome.
- Foot skin or a wound that turns black or smells bad, a possible sign of gangrene.
Get care the same day
- You have diabetes or reduced feeling in your feet and notice a cut, blister or sore that is red, warm or painful or isn't healing after a few days.
Make a prompt appointment
- New foot weakness, curling toes, visible shrinking of foot muscles, or numbness that has become constant
- A lump or swelling on the inside of the ankle with tingling into the sole
- Burning, tingling or numbness in the sole lasting more than a few weeks
- Numbness in both feet, which needs a medical workup for polyneuropathy
Self-care tips that may help limit flare-ups
- While symptoms settle, break up long periods of standing or walking and stick with supportive shoes; these tips for walking with nerve symptoms can help you pace it.
- If you ice the inner ankle, put a thin towel between the ice and your skin and limit it to 20 minutes at a time. Skip ice on numb skin, since you may not feel cold damage.
- Warm up and stretch before exercise, and rest between workouts.
- Aim for a healthy body weight.
- If your sole is numb, check your feet every evening for cuts, blisters or a pebble in your sock.
- Log when and where symptoms flare for your clinician.
Where Neuro-Blast fits
Tarsal tunnel syndrome comes from pressure on a nerve in a narrow channel, and a supplement doesn't change that pressure, which is why the exam, tests and treatment options above matter. A supplement doesn't diagnose or treat the cause, and doesn't replace medical care.
Neuro-Blast capsules and the Neuro-Blast oral spray are dietary supplements formulated to support healthy nerve function; the capsules are formulated with PEA, alpha-lipoic acid and B vitamins. As noted above, large doses of vitamin B6 can themselves cause numbness. Each two-capsule serving contains 40 mg of vitamin B6: below the U.S. adult upper limit of 100 mg a day, but above the 10 mg a day from supplements the NHS advises without a doctor's recommendation. Ask your clinician before starting, and stop and call them if new numbness or tingling begins. The oral spray carries its own Supplement Facts label; the 40 mg above is the capsule amount, so read each label and count the B6 in everything you take. Alpha-lipoic acid in the capsules may lower blood sugar, so check with your prescriber if you take diabetes medicines.
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Frequently asked questions
What can be mistaken for tarsal tunnel syndrome?
Common look-alikes include plantar fasciitis, Baxter's nerve entrapment at the heel, polyneuropathy and S1 radiculopathy from the lower back. Some can occur alongside it.
How can you tell tarsal tunnel syndrome from plantar fasciitis?
Tarsal tunnel syndrome usually causes burning, tingling or numbness in the sole that worsens with standing, walking or at night. Plantar fasciitis causes heel pain that is worst with the first steps in the morning. The two can occur together.
Can tarsal tunnel syndrome go away without surgery?
Many people improve without an operation. In one 5-year study, 65% of feet had satisfactory results with non-surgical treatment. The outlook depends on the cause, severity and how long symptoms have lasted.
How long does it take to recover from tarsal tunnel surgery?
Improvement is usually gradual. In one study of 81 patients who had ultrasound-guided release, scores barely changed for 6 months, then kept improving through 18 months. Tingling, pain and swelling can briefly increase after surgery and take up to a year to settle.
Can tarsal tunnel syndrome cause permanent nerve damage?
It can. Some people have long-lasting nerve pain or a partial or complete loss of feeling or movement, but full recovery is possible when the cause is found and successfully treated. Early diagnosis improves the chance of controlling symptoms.
This article is for general education and is not a substitute for personalized medical advice. Talk with your healthcare provider about your symptoms and before starting any supplement.
