Tarsal Tunnel Syndrome

The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bones. The tunnel is covered with a thick ligament (the flexor retinaculum) that protects and maintains the structures contained within the tunnel—arteries, veins, tendons, and nerves. One of these structures is the posterior tibial nerve, which is the focus of tarsal tunnel syndrome.  Tarsal tunnel syndrome is a compression, or squeezing, on the posterior tibial nerve that produces symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.

Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.


  • Tingling, burning or a sensation similar to an electric shock
  • Numbness, which may occur on the inside of the ankle or bottom of the foot
  • Pain, including shooting pain can occur in just one spot. In others, it may extend to the heel, arch, toes, and even the calf
  • These symptoms might appear suddenly or aggravated by overuse of the foot, such as in prolonged standing, walking, exercising, or beginning a new exercise program

Causes and Risk Factors

  • An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve
  • Systemic diseases such as diabetes or arthritis can cause swelling, thus compressing the nerve
  • Having a large or abnormal structure that occupies space within the tarsal tunnel.  examples include a varicose vein, ganglion cyst, swollen tendon, and arthritic bone spur.
  • A person with flat feet is at risk for developing tarsal tunnel syndrome, because the outward tilting of the heel that occurs with “fallen” arches can produce strain and compression on the posterior tibial nerve.

Complications of Tarsal Tunnel Syndrome

  • Several complications can arise from compression release surgery-resulting in deleterious effects on foot function.
  • Persistant pain in the medial heel region after decompression surgery.  
  • Commonly plantar fasciitis may be result of prolonged tarsal tunnel syndrome  and needs to be addressed separately.  


  • Warm up and stretch properly before activity.
  • Maintain physical fitness:

    -Strength, flexibility, and endurance.

  • Cardiovascular fitness (increases heart rate).
  • Wear properly fitted shoes.
  • Wear arch supports (orthotics), if you have flat feet.
  • Protect the ankle with taping, braces, or compression bandages.
Things to do at home
  • Applying ice for ten minutes at a time to reduce pain and inflammation 
  • Using elastic bandage to prevent movements that might cause further damage.
  • Elevation of the foot to promote healing but also not discontinuing physical activity, to maintain strength.
  • Flattened foot arches may improve by using specialized or customized inserts, or orthotics placed inside the shoes. These devices help relieve foot pronation, a common condition where the inner edge of the foot rolls in and flattens the arch of the foot. Pronation stretches and irritates the tibial nerve in the tarsal tunnel. 

How we treat Tarsal Tunnel Syndrome

We use the following approaches to treat tarsal tunnel syndrome.


  • ASTR® Tools: Our doctors use a variety of ASTR® tools to release scar tissue and myofascial restriction, which can decrease mobility and flexibility.
  • Special exercise program to decrease pain, strengthen the muscles, stabilize and help the patient to return to normal function and activities.
  • Special instructions on how to speed up the recovery time.
  • Cold Laser Therapy: Tissue inflammation is common with tarsal tunnel syndrome. Cold laser is used in order to decrease inflammation that causes pressure on the affected area.
  • PEMF treatment which utilizes a form of electromagnetic therapy that stimulates cellular repair and recharges the body’s cells to optimize its performance.  This treatment is especially recommended for Tarsal tunnel syndrome. You can expect immediate results in as little as ten minutes in most cases.
  • Patient avoided hip surgery.

  • Patient avoided back surgery.

  • This newborn came in unable to move his neck from the side position. He suffered from torticollis, severe neck and back spasms. After just 1 ASTR treatment, he had complete range of motion.

  • Patient came in unable to move his neck from the side position. After 3 ASTR treatments, he regained full range of motion.

  • This young gymnast came in unable to do the splits. After just 1 ASTR treatment, she had full range of motion.


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