Tarsal Tunnel Syndrome: Anatomy, Electrodiagnosis, and Surgical Decompression

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

Tarsal tunnel syndrome (TTS) — compression neuropathy of the posterior tibial nerve (or its branches) as it passes posterior and inferior to the medial malleolus beneath the flexor retinaculum — produces medial ankle and plantar foot burning, tingling, and numbness that can be confused with plantar fasciitis, peripheral neuropathy, and radiculopathy. The distinction matters because each requires a fundamentally different treatment approach, and TTS producing a compressive lesion is surgically correctable.

Anatomy and Etiology

The tarsal tunnel — bounded by the medial malleolus anteriorly, the posterior calcaneus and talus posteriorly, and the flexor retinaculum superficially — contains the tibialis posterior tendon, flexor digitorum longus, posterior tibial artery, posterior tibial nerve, and flexor hallucis longus (Tom, Dick, And nervous Harry — the mnemonic for tunnel contents in order). The posterior tibial nerve divides within or just distal to the tunnel into the medial plantar nerve, lateral plantar nerve, and medial calcaneal branches. TTS etiology: space-occupying lesion within the tunnel (ganglion cyst — the most common surgically identifiable cause; lipoma; varicosity; exostosis), post-traumatic fibrosis after ankle fracture, and idiopathic. Pes planus (flatfoot) compresses the tarsal tunnel by traction and deformation of the tunnel contents.

Electrodiagnosis and Surgery

Nerve conduction studies: distal motor latency of the medial or lateral plantar nerve >4.5ms suggests TTS; sensory NCS of the medial plantar nerve is the most sensitive electrodiagnostic test. MRI of the tarsal tunnel is mandatory before surgery to identify space-occupying lesions that, if present, produce the highest surgical success rates (90%+). Surgical decompression: complete release of the flexor retinaculum from the medial malleolus to the abductor hallucis fascia; excision of any space-occupying lesion; neurolysis of the medial and lateral plantar nerve branches. Outcomes are significantly better with identifiable compressive etiology than idiopathic TTS. Dr. Biernacki at Balance Foot & Ankle evaluates medial ankle and plantar foot neuropathic symptoms with clinical examination and coordinates NCS/EMG for electrodiagnostic confirmation. Call (810) 206-1402 at our Bloomfield Hills or Howell office.

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When to See a Podiatrist

Many foot conditions can be managed conservatively at home, but some require professional evaluation. See a podiatrist promptly if you experience:

• Pain that persists for more than 2 weeks despite rest
• Swelling, redness, or warmth that isn’t improving
• Numbness, tingling, or burning in the feet
• A wound or sore that is not healing within 2 weeks
• Any foot concern if you have diabetes or poor circulation
• Nail changes that suggest fungal infection or other problems

At Balance Foot & Ankle, our three board-certified podiatrists — Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin — provide comprehensive foot and ankle care at our Howell and Bloomfield Township offices. Most insurance plans are accepted.

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Board-certified podiatrists Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients daily at our Howell and Bloomfield Township, MI offices.

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Tarsal Tunnel Syndrome: Complete Guide to Diagnosis & Treatment

Burning, tingling, and numbness in the foot from tarsal tunnel syndrome requires expert evaluation. Our podiatrists use clinical testing, nerve conduction studies, and MRI to accurately diagnose tibial nerve compression and provide targeted treatment.

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Clinical References

1. Ahmad M, Tsang K, Mackenney PJ, Adedapo AO. Tarsal tunnel syndrome: a literature review. Foot Ankle Surg. 2012;18(3):149-152.
2. Franson J, Baravarian B. Tarsal tunnel syndrome: a compression neuropathy involving four distinct tunnels. Clin Podiatr Med Surg. 2006;23(3):593-609.
3. Gondring WH, Shields B, Wenger S. An outcomes analysis of surgical treatment of tarsal tunnel syndrome. Foot Ankle Int. 2003;24(7):545-550.

In-Office Treatment at Balance Foot & Ankle

If home care isn’t resolving your your foot or ankle concern, a visit with a board-certified podiatrist is the fastest path to accurate diagnosis and a personalized plan. At Balance Foot & Ankle Specialists, Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin offer same-day and next-day appointments at both our Howell and Bloomfield Hills offices. We perform on-site diagnostic ultrasound, digital X-ray, conservative care, advanced regenerative treatments, and minimally invasive surgery when indicated.

Call (810) 206-1402 or request an appointment online. Most insurance plans accepted, including Medicare, Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare.

Most Common Mistake We See

The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.

Warning Signs That Need Same-Day Care