Tarsal tunnel syndrome is a painful condition of the foot caused by pressure on the posterior tibial nerve as it passes along a passage called the tarsal tunnel just below the bony bit on the inside of the ankle.

Symptoms of Tarsal Tunnel

Symptoms include pain which is often described as a burning pain radiating into the arch of the foot, heel and sometimes the toes. Pins and needles or numbness may be felt in the sole of the foot. Pain may be worse when running or when standing for long periods of time and often worse at night. The area under the medial malleolus on the inside of the ankle may be tender to touch. The Tinels Test is used to diagnose tarsal tunnel syndrome. This involves tapping the nerve just behind the medial malleolus or bony bit of the ankle with a rubber hammer. Pain indicates a positive test.

Causes of Burning Pain on Your Ankle

Tarsal tunnel syndrome occurs when the posterior tibial nerve which passes down the inside of the ankle becomes compressed or trapped. If you over pronate where your foot rolls in when you walk or run then this can contribute to compression of the nerve. Because over pronation is a key factor, it is common for the problem to occur in both feet at the same time. In people involved in running or running based sports, where the condition occurs spontaneously, then over pronation is the most frequent cause.

Rest from any aggravating activities and apply cold therapy whilst in the acute phase when the foot or ankle is painful and inflamed. Once the initial pain and inflammation has gone then a full rehabilitation program which includes stretching and strengthening exercises for the foot can begin. Nerve conduction studies may be done to confirm the diagnosis and indicate the location of the entrapment. 

foot stretches

Diagnosing Tarsal Tunnel

An X-ray or MRI may also be useful to determine the presence of any other structures such as cysts, arthritis or a tarsal coalition. If conservative treatment fails then a corticosteroid injection may be administered. For stubborn and persistent cases surgery may be required to decompress the nerve. The operation is undertaken to decompress the nerve by freeing the soft tissue structures in the area, creating more space for the nerve. The procedure itself is very fast.

Brad Schaeffer, D.P.M.
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Dr. Brad Schaeffer is an expert in foot and ankle pain, treatment and surgery. Learn more about our doctor.
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Becky 03/10/2018 09:17 PM
This article explained so much! I'm sitting here with the burning pain after a day of non-stop running. Gonna go get an ice pack now. Thanks for the help!
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Devinder Gill 05/12/2018 04:19 PM
Ankle burning inside for last two months every day I hate it, I am 56 year old
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Dee 05/27/2019 12:19 PM
Relief reading this as sounds exactly what my problem is.Ive been suffering with these symptoms now for about ten weeks having tried painkillers to no avail .Is a visit to doctor adviseable or direct to physio? I have been told that same side knee is arthritic & know for a fact that due to the knee pain I am walking with a limp causing that foot to turn but 6weeks of physio didn’t help the knee problem!
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Best Knee Care Hospital in India 06/11/2022 05:31 AM
This is a very informative blog. I really learn a lot from here. Thanks for posting!
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