Tarsal Tunnel Release Surgery — Tibial Nerve Decompression Michigan

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

When Tarsal Tunnel Syndrome Requires Surgical Release

Tarsal tunnel syndrome — compression of the posterior tibial nerve within the fibro-osseous tarsal tunnel posterior to the medial malleolus — is initially managed conservatively with custom orthotics, corticosteroid injection into the tarsal tunnel, and activity modification. However, when conservative management fails after 3–6 months, surgical tarsal tunnel release (tibial nerve decompression) reliably provides symptom relief that conservative measures cannot achieve for structural compression. At Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan, Dr. Tom Biernacki, DPM evaluates tarsal tunnel syndrome and coordinates surgical decompression for appropriate candidates. Call (810) 206-1402.

Pre-Surgical Evaluation — Confirming the Diagnosis

Before surgical decompression, the tarsal tunnel syndrome diagnosis must be confirmed with objective testing — not clinical examination alone. Required pre-surgical workup: nerve conduction velocity (NCV) and electromyography (EMG) studies by a neurologist or physiatrist — abnormal sensory amplitude or velocity across the tarsal tunnel provides objective confirmation of nerve compression and helps predict surgical success; MRI of the ankle to identify space-occupying lesions (ganglion cyst, lipoma, accessory muscles, varicose veins) compressing the nerve — space-occupying lesion excision combined with flexor retinaculum release has the highest success rate; and careful exclusion of proximal causes (L4–S1 radiculopathy, diabetic neuropathy, systemic inflammatory neuropathy) that can mimic tarsal tunnel syndrome and do not respond to tarsal tunnel release.

The Surgical Procedure — Tarsal Tunnel Release

Tarsal tunnel release is performed under regional anesthesia with sedation as an outpatient procedure: an incision is made posterior to the medial malleolus; the flexor retinaculum (the roof of the tarsal tunnel) is divided along its entire length, decompressing the posterior tibial nerve and its branches; the medial and lateral plantar nerve branches are followed distally and released from any fascial bands or scar tissue; if a space-occupying lesion is identified on preoperative MRI, it is excised; any intraneural scarring (epineurotomy) is addressed if present. The procedure takes approximately 45–60 minutes. Wound closure is meticulous — the nerve must not be kinked or re-compressed during closure.

Recovery and Expected Outcomes

Post-tarsal tunnel release recovery: non-weight-bearing with crutches for 2–3 weeks; cam boot for weeks 3–6; gradual return to normal footwear at 6–8 weeks; full activity return at 3–4 months. Nerve healing is the rate-limiting step — relief from burning and tingling symptoms typically begins at 4–8 weeks but continues improving for 12–18 months as the nerve regenerates. Published success rates for tarsal tunnel release: 75–85% for idiopathic compression; 85–90% for space-occupying lesion removal; and 50–65% for diabetic patients with concurrent peripheral neuropathy (the lower success rate in diabetics reflects partial non-reversible neuropathic injury). Early surgical intervention — before prolonged nerve compression causes permanent axonal damage — provides the most complete recovery.

Baxter’s Nerve Release — The Extended Decompression

In patients with concurrent inferior calcaneal nerve (Baxter’s nerve) entrapment — the first branch of the lateral plantar nerve — the decompression is extended to include release of the abductor hallucis fascia and the medial calcaneal nerve as it passes between the abductor hallucis and quadratus plantae. This extended decompression is appropriate when clinical examination shows both tarsal tunnel findings (plantar foot burning/tingling) and Baxter’s nerve findings (medial heel burning without the morning-improvement pattern of plantar fasciitis). Combined decompression at a single surgical procedure provides comprehensive relief when both nerve entrapments are confirmed.

Tarsal Tunnel Evaluation & Surgical Coordination in Howell & Bloomfield Hills Michigan

Dr. Tom Biernacki, DPM evaluates tarsal tunnel syndrome with clinical Tinel’s testing, coordinates NCV/EMG studies, and manages pre-operative and post-operative care for tarsal tunnel release at Balance Foot & Ankle. Serving Howell, Brighton, Birmingham, Bloomfield Hills, Troy, Auburn Hills, and all Southeast Michigan. Book your evaluation or call (810) 206-1402.

Tarsal Tunnel Syndrome Treatment in Michigan

Tarsal tunnel syndrome causes burning, tingling, and numbness in the foot from compressed tibial nerve. Our podiatrists provide accurate diagnosis with nerve conduction studies and offer both conservative and surgical decompression options.

Explore Our Nerve Treatment Options → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Ahmad M, et al. Tarsal tunnel syndrome: a literature review. Foot Ankle Surg. 2012;18(3):149-152.
2. Kinoshita M, et al. The dorsiflexion-eversion test for diagnosis of tarsal tunnel syndrome. J Bone Joint Surg Am. 2001;83(12):1835-1839.
3. Lam SJS. Tarsal tunnel syndrome. J Bone Joint Surg Br. 1967;49-B(1):87-92.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.