Tarsal tunnel syndrome: burning or tingling in the sole, and what helps

What it isStrong evidence

The tarsal tunnel is a narrow passage behind and below the bony bump on the inside of the ankle, roofed by a band of tough tissue (the flexor retinaculum). Three tendons, an artery, veins and the tibial nerve run through it. In or near the tunnel the nerve splits into two branches that supply the sole (the medial and lateral plantar nerves), and a small branch supplies the skin of the heel.

Tarsal tunnel syndrome means the nerve or its branches are squeezed in this tunnel. The branches then pass under a muscle on the inner side of the foot (abductor hallucis), so they can also be squeezed just below the ankle. One small branch there, sometimes called Baxter's nerve, can cause heel pain when it is trapped.

Sources 1, 2, 3

How it feelsEmerging evidence

Burning, tingling, pins and needles or numbness in the sole, heel or inner ankle, sometimes with shooting pain. It can spread into the toes or, less often, up the calf. In one series of 59 people, tingling or burning was the commonest symptom (86% of feet), followed by pain (55%).

It is usually in one foot: only 6 of those 59 people had it in both. It tends to build with standing and walking and as the day goes on, is often worse at night, and is eased by rest, raising the foot or rubbing it.

Sources 4, 2, 5

How it's recognisedEmerging evidence

A clinician presses and taps over the nerve behind the inner ankle bone. Pressing hurts in 60 to 100% of people with it, and tapping sends tingling into the foot (Tinel's sign) in more than half. Holding the foot pulled up and turned out, with the toes bent back, brought on symptoms in 82% of 44 feet that later had surgery, and in none of 100 healthy feet.

These tests aren't specific, though. In cadavers, that position also stretches the plantar fascia, and the usual test for plantar fasciitis also stretches the nerves in the sole, so neither test cleanly separates the two. Late signs are numbness on testing, weak toe muscles and wasting of the small foot muscles.

Sources 2, 6, 7

Who gets it, and whyEmerging evidence

It is uncommon, and nobody knows exactly how common. Some authors think it is often missed; experienced nerve surgeons warn that it is diagnosed too often. It is more common in women, and is seen in active people and runners. Reviews of case series list these causes:

• A past ankle injury, such as a sprain or a fracture, in 17 to 43% of cases.
• Something taking up space in the tunnel: a ganglion (a fluid-filled lump, in up to 8%), swollen or tangled veins, a fatty lump or, rarely, a nerve tumour.
• Swollen tendon sheaths, arthritis, an extra or enlarged muscle, or a bar of bone or tough tissue joining two foot bones (a tarsal coalition).
• Foot shape: a heel that tips outwards or a foot that rolls in. In cadavers, turning the foot fully outwards raised the pressure in the tunnel from 2 to 32 mmHg (millimetres of mercury), and turning it fully inwards raised it to 17.
• Conditions that affect the whole body: diabetes, an underactive thyroid, or kidney failure needing dialysis.
• No cause found in about a fifth to over half of cases, depending on the series. In one surgical series of 50 feet, 18 had a ganglion, 15 a tarsal coalition and 9 no clear cause.

Sources 1, 3, 2, 8, 9, 5, 10

Plantar fasciitis, a trapped heel nerve, or both?Emerging evidence

Tarsal tunnel syndrome is often mistaken for plantar fasciitis, and a trapped nerve at the heel, especially Baxter's nerve, is a recognised cause of heel pain with or without plantar fasciitis. The two can occur together: in a clinic that injected 218 people for tarsal tunnel syndrome, 38% of the 68 who had an MRI (magnetic resonance imaging) scan also showed signs of plantar fasciitis.

A third look-alike is irritation of the big toe's long tendon (flexor hallucis longus), which runs through the same tunnel. In 81 people with it, the pain was behind the inner ankle in 40 and under the heel in 23, and 45 had already had treatment that didn't work, usually for plantar fasciitis.

Clues that point to the nerve: burning, tingling or numbness; symptoms that build with standing and at night, rather than pain on the first steps that eases; and tingling when the inner ankle is tapped. Don't try to settle this on your own: the NHS advises seeing a GP for tingling or loss of feeling in the foot.

Sources 3, 11, 12, 13, 14, 15

Diabetic nerve damage, or a trapped nerve?Emerging evidence

Peripheral neuropathy (damage to the nerves of the hands and feet) affects about 1 in 10 people aged 55 or over in the UK, and diabetes is its commonest cause here. It usually starts in both feet, in the toes, and creeps upwards, with numbness, burning or stabbing pain and poor balance. Tarsal tunnel syndrome is usually one foot, centred on the inner ankle and sole.

They can occur together. Tapping over the nerve at the ankle set off tingling in 45% of 416 people with diabetes and in about a quarter of 196 without. In a group of people with diabetes, those with tarsal tunnel syndrome in both feet developed more new foot ulcers over about 2 years (17% against 8%). So any new numbness or pain in the feet with diabetes needs your diabetes team or GP.

Sources 16, 17, 4, 18, 19

When the back is the source

A trapped nerve root in the lower back can also cause tingling in the sole of one foot. In 561 people with a trapped nerve root in the lower back, 27 (about 5%) also had tarsal tunnel syndrome. Back pain, or symptoms running down the back of the leg, point to the sciatica guide.

Sources 3, 20

What tests and scans do and don't showEmerging evidence

Nerve conduction studies can support the diagnosis, but an evidence review couldn't work out how often they get it right or wrong, and the results need comparing with the other foot. In 32 feet that had surgery, the test results didn't predict who did well.

A tingle when the ankle is tapped isn't proof either: it was found in about a quarter of people without diabetes or any nerve symptoms.

An ultrasound or MRI scan looks for a cause, such as a ganglion, swollen veins or a lump, and helps plan surgery; MRI found a relevant problem in 85 to 88% of people with the diagnosis. A scan isn't needed for everyone. It matters when a lump is felt, symptoms are getting worse, or surgery is being considered.

Sources 21, 1, 2, 22, 18, 3

How it usually goesMixed evidence

There is little good evidence on how it goes without treatment. In one small series, 6 of 9 people who had no treatment improved or recovered. In one clinic's records of 218 people given a guided steroid injection, 77.5% did not go on to have surgery over an average of 11 months, but there was no comparison group, so some would have settled anyway. Only three studies have reported the results of non-surgical care at all.

Sources 5, 13, 1

Non-surgical care comes first, on thin evidenceMixed evidence

Every review agrees that non-surgical care comes first: less of the standing, walking or running that brings it on, supportive shoes or insoles, physiotherapy, medicines for nerve pain, and sometimes an injection. Every review also agrees that the evidence is weak. A German nerve surgery review says no evidence-based data on non-surgical treatment exist, and a 2017 review calls the field 'still more opinions than evidence'.

A 2022 systematic review found only 3 studies reporting the results of non-surgical care and 14 of surgery, almost all of them case series, and no study comparing the two. So nobody can say from trials whether surgery does better than good care without it.

Sources 1, 2, 23, 3, 24

Nerve glides: two small, short trialsEmerging evidence

Nerve glides (nerve mobilisation) move the nerve through its path without stretching it hard. Two small randomised trials added them to standard physiotherapy. In 28 people over 6 weeks, both groups improved in movement, strength and pain with no difference between them, and only the glide group showed a clear improvement in feeling (light touch and two-point discrimination) and in Tinel's sign. In 54 people over 4 weeks, adding tibial nerve 'flossing' improved foot pain, ankle movement and nerve conduction more, though not the foot position test.

That is small, short-term evidence, and we could read only the trials' summaries, so the doses in the plan come from the move's NHS dose instead. Cadaver studies explain the idea: pulling the foot up tightens the tibial nerve and slides it down, more so with the knee straight, so moving one end into tension while the other end is slack moves the nerve with less strain.

Sources 25, 26, 27, 28

Shoes, insoles and less standingMixed evidence

Cutting down the standing, walking or running that brings it on is universal advice. Arch supports, a wedge under the inner heel or supportive shoes are suggested for a foot that rolls in, because turning the foot outwards raises the pressure in the tunnel in cadavers. The results are mixed: in one series, shoe inserts helped only 34% of the time, and only with flexible feet, and a nerve surgery review says inserts make symptoms worse in many cases. They are worth trying if your foot rolls in; stop if they make the tingling worse (our suggestion).

A clinician may also use a night splint, a walking boot or a brace for a while to rest the area. An NHS surgical service lists a calf stretch programme, ice packs, changing your activity, painkillers, different footwear, an in-shoe support and steroid injections as the alternatives to surgery.

Sources 3, 24, 9, 2, 29

Medicines for nerve pain (borrowed from nerve pain in general)Emerging evidence

For nerve pain, the National Institute for Health and Care Excellence (NICE) recommends amitriptyline, duloxetine, gabapentin or pregabalin as first choices, and capsaicin cream for nerve pain in one area for people who want to avoid tablets. The NHS notes that ordinary painkillers often don't help nerve pain. This guidance covers nerve pain in general and hasn't been tested in tarsal tunnel syndrome itself. Anti-inflammatories may help when a swollen tendon sheath or arthritis is the cause. These are decisions for your GP.

Sources 30, 16, 1, 3

A guided steroid injection: one clinic's recordsEmerging evidence

A local anaesthetic and steroid injection into the tunnel, ideally guided by ultrasound, is used mainly when swelling or inflammation is the cause. In one clinic's records of 218 people given an ultrasound-guided injection, 169 (77.5%) did not go on to have surgery over an average of 339 days. There was no comparison group, so some might have settled anyway. In an older series, 6 of 9 people given injections did well. A nerve surgery review advises against repeated injections.

Sources 13, 5, 2, 1

Surgery helps some people, especially with a clear causeMixed evidence

Tarsal tunnel release divides the band over the tunnel and frees the nerve branches into the sole. Success rates in case series range from 44% to 96%. In 32 feet followed for 31 months, 44% had a good or excellent result and 38% a poor one. In 60 people, 85% improved on examination but only 51% said they were free of symptoms. In 62 people, a foot score rose from 61 to 80 out of 100, and getting back to usual activity took 9 months on average.

It works best with a clear cause that can be removed, such as a ganglion or a tarsal coalition, a short history (under a year), a positive Tinel's sign and a younger age. Results are worse when no cause is found, after an injury, and with long-standing symptoms, nerve damage, diabetes or obesity. When to operate is uncertain: one review says try non-surgical care for at least 12 to 24 months, another up to 6 months for severe pain with a clear diagnosis. Weakness, muscle wasting or a lump on a scan are reasons to see a surgeon sooner. The problem comes back after surgery in under 5%, and repeat operations are less predictable.

Recovery, from one NHS service: usually a day case, a cast for about a week and then a walking boot for about 2 weeks, desk work at about 4 weeks and manual work at about 6, sport considered at 8 to 16 weeks, and the full benefit by 6 to 12 months. The risks it lists include problems with circulation, a thick or tender scar, areas of numbness, the problem coming back and being made worse. Your surgical team's plan comes first.

Sources 3, 4, 22, 2, 24, 10, 8, 29

Nerve decompression for diabetic nerve damage: unprovenMixed evidence

Some surgeons free several leg nerves for painful nerve damage from diabetes in both feet. A 2008 Cochrane review found no randomised evidence. Later trials without a dummy operation reported less pain after surgery: in 42 people with one leg operated and the other as the comparison, and in 22 people compared with observation.

But in the one trial with a sham (dummy) operation, in 78 people, the operated and sham-operated legs improved equally at 12 months. At 56 months the operated legs were a little better, by 1.6 points on an 11-point scale, and the authors say a placebo effect may explain part or all of the benefit. A 2026 review of 7 trials (207 people) found a high risk of bias, no proven benefit for feeling, balance, ulcers or quality of life, and wound problems in 24% of operated patients, and called it investigational. This is a different question from tarsal tunnel syndrome in one foot.

Sources 31, 32, 33, 34, 35

A nerve glide aimed at the ankle (written steps)

The seated slider in the plan straightens the knee while pointing the toes and looking up, which glides the nerve higher up the leg. To aim it at the tibial nerve at the ankle, keep the same rhythm but change what the foot does. This version is our adaptation and has no 3D demo: cadaver studies show that pulling the foot up tightens the tibial nerve and bending the knee slackens it, and the two small trials used nerve glides, though their exact exercises weren't in the summaries we could read.

• 1. Sit tall on a firm chair with both feet flat.
• 2. Slide the foot back a little so the knee bends more, and gently pull the foot and toes up towards you. The nerve is now tighter at the ankle and slacker at the knee.
• 3. Then straighten the knee as you point the foot and toes away. The tension moves up the leg as the ankle end slackens.
• 4. Keep the two movements smooth and in time: 10 slow repetitions, 2 to 3 times a day.
• 5. Stop at the first sign of tingling, burning or numbness, and use a smaller range next time.
• 6. If even this stirs symptoms, go back to the slider in the plan, which keeps the ankle pointed.

Sources 27, 28, 25, 26

Shoes, laces and standing

Wear supportive, roomy shoes, with an arch support if your foot rolls in, and stop using an insert that makes the tingling worse. Loosen laces, straps or boot collars that press behind the inner ankle (our suggestion). Break up long spells of standing, sit for tasks where you can, and swap some walking for cycling while it settles.

Sources 3, 24, 9, 2

If you have diabetes

Trapped nerves at the ankle are more common with diabetes, and they can occur alongside diabetic nerve damage. Tell your diabetes team or GP about any new numbness, burning or pain; the NHS recommends regular check-ups of nerve function for people at higher risk, such as people with diabetes. Nerve decompression surgery for nerve damage in both feet is unproven. Our guide to exercise for peripheral neuropathy covers staying active with numb feet.

Sources 16, 18, 19, 35