Tarsal Tunnel Syndrome

Several conditions can feel similar. The main ones to rule out are ^2,6:

• Plantar fasciitis: irritation of the thick band of tissue running along the sole from your heel.
• Peripheral neuropathy: more widespread nerve damage, for example from diabetes.
• A nerve root irritated in your lower back: the S1 nerve root in particular can send symptoms into the foot, as in sciatica.
• Morton's neuroma: an irritated nerve between the toes.
• Heel spurs: bony growths on the heel bone, another cause of pain under the heel ⁸.

What points towards the tarsal tunnel is nerve-type symptoms (burning, tingling, numbness) plus a tap test at the inner ankle, called Tinel's sign, that reproduces them ^1,2. A negative tap test doesn't rule it out: studies differ widely on how often it's positive in people with the condition ⁵.

Scans need careful reading. There's no gold-standard test, and nerve studies, ultrasound and provocative tests all vary widely in how reliably they pick it up ⁵. MRI can show compression, but false positives are a real concern ⁶. A scan backs up the examination. It doesn't replace it, and you won't always need one ¹.

No single test confirms tarsal tunnel syndrome ⁵, so it comes down to your story and an examination. The usual story is burning or tingling in the sole that builds with standing and eases with rest ⁴. The main test is a tap behind your inner ankle bone. If it sends your usual zing into the arch or toes, that's a positive Tinel's sign ¹. Pressing on the nerve, or holding the foot turned in or out, can do the same ⁴.

You won't always need a scan ¹. Nerve conduction tests measure how well the nerve carries a signal, though they miss more cases here than with other trapped nerves ⁴. Ultrasound or MRI is for finding a cyst or something else taking up room, usually once rest and an insole haven't helped ¹.

Treatment research here is thin, and hard evidence that these approaches work is lacking ⁴. Conservative care is still the accepted first step and settles symptoms for many people, but that rests on only a handful of studies ⁴.

A squeezed nerve does not mend on a schedule the way a sprain does, so The Well Motion Recovery Path™ for tarsal tunnel syndrome is paced by how the nerve behaves, not by a date.

• Reset: from the first visit. Assessment, easing the load, a shoe change and an insole or heel wedge to take pressure off the nerve ¹. If it began with an ankle injury, one review advises limited weight bearing and an ankle brace for up to 6 weeks ⁹. Expect good days and bad days. We move you on once ordinary standing and flat walking stop building the symptoms.
• Rebuild: nerve mobility and hands-on work, with taping for the arch as time on your feet goes up ². Expect the odd flare. It means hold the load, not stop. We move you on when your foot does what your daily tasks ask of it.
• Return: full days on your feet, hills and, for some, running through sports physiotherapy. We test what used to set it off. You leave with a footwear and flare-up plan.

How long it usually takes. No study gives a reliable recovery time. The 6 week figure is one review's advice, not a trial result ⁹. How long you have had symptoms is linked to recovery ³. If it is not settling, a scan or a surgeon's opinion decides the next step ^1,4.

Nobody has run a trial on preventing tarsal tunnel syndrome, so these come from what's known to crowd or stretch the nerve:

• Skip the completely flat shoes. A heel of about 2 cm takes some of the squeeze off the nerve ¹. Flat feet raise your risk because the shape of the rearfoot stretches and compresses it, which is why an insole that changes that position can help ¹.
• Break up long spells on your feet. Long periods of repetitive weight-bearing are a recognised risk factor, and so is playing sport ⁴. If you walk for fitness, keep to flat ground and leave the hills for now ¹.
• Don't train through a swollen inner ankle. Inflammation there, from an old injury or overworked tendons, is one of the known causes ¹. Cut back and let it settle ¹.
• Mention diabetes or a thyroid problem. Tarsal tunnel syndrome is more common with diabetes, and the tissue swelling of an underactive thyroid can bring it on ⁴. Whoever examines your foot needs to know.