Tarsal Tunnel Syndrome in SE Michigan | Causes, Diagnosis & Treatment

Quick answer: Tarsal Tunnel Syndrome Michigan 4 is a clinical condition that responds to evidence-based treatment when caught early. Symptoms include pain, swelling, and altered function. Diagnosis requires clinical exam, often imaging. Treatment ladder: conservative care first (4-6 weeks), then targeted interventions if needed. Call (810) 206-1402.

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

Tarsal tunnel syndrome (TTS) — compression of the posterior tibial nerve and its branches within the fibro-osseous tarsal tunnel posterior to the medial malleolus — is the foot’s analog of carpal tunnel syndrome, though it is both less common and more frequently misdiagnosed. Patients with TTS present with burning, tingling, and numbness on the plantar foot, inner heel, and toes — symptoms that are often attributed to plantar fasciitis, diabetic neuropathy, or lumbar radiculopathy before the correct diagnosis is established. At Balance Foot & Ankle in Southeast Michigan, Dr. Tom Biernacki evaluates suspected tarsal tunnel syndrome with a systematic clinical and electrodiagnostic approach.

Anatomy and Causes

The tarsal tunnel is a fibro-osseous channel posterior and inferior to the medial malleolus, formed by the flexor retinaculum spanning from the medial malleolus to the calcaneus. The tunnel contains the posterior tibial nerve (and its branches — medial plantar, lateral plantar, and calcaneal nerves), FHL, FDL, and posterior tibial tendon, and the posterior tibial artery. Any space-occupying lesion or anatomical narrowing compresses the posterior tibial nerve: space-occupying lesions (most treatable cause) — ganglion cyst (most common), lipoma, varicosity, accessory muscle, or tarsal coalition occupying tunnel space; excessive pronation or flat foot — the valgus heel position stretches and tensions the posterior tibial nerve with every step; post-traumatic scarring — after ankle fractures or severe ankle sprains that cause hemorrhage in the tunnel; systemic causes — hypothyroidism, rheumatoid arthritis, diabetes (all associated with nerve edema that fills the available tunnel space).

Diagnosis and Treatment

Clinical examination: Tinel’s sign (percussion over the tarsal tunnel posterior to the medial malleolus reproducing the burning/tingling into the plantar foot) is the most sensitive clinical test — sensitivity approximately 90% in confirmed cases. Two-point discrimination and monofilament sensory testing of medial and lateral plantar nerve distributions. Electrodiagnostic studies (EMG/NCS): posterior tibial motor nerve conduction to the abductor hallucis and abductor digiti minimi; medial and lateral plantar sensory NCS. EMG/NCS has approximately 60–80% sensitivity for TTS — a negative study does not rule out the diagnosis. MRI: gold standard for identifying the causative space-occupying lesion — essential before surgical decompression. Conservative treatment: orthotic correction of excessive pronation (the most commonly modifiable cause), activity modification, NSAID therapy, and cortisone injection into the tarsal tunnel for inflammatory causes. Conservative treatment succeeds in 50–60% of cases without a discrete space-occupying lesion. Surgical decompression: indicated for: TTS with identified space-occupying lesion (highest success rate — 85–90%); failure of conservative treatment for 3–6 months in appropriately selected patients. Surgical technique: incision posterior to the medial malleolus, division of the flexor retinaculum, complete exploration of the tunnel to remove the causative lesion. Recovery: 6–8 weeks in a boot, return to normal shoes at 8–10 weeks.

Frequently Asked Questions

Burning foot pain that doesn’t respond to standard heel pain treatment? Tarsal tunnel syndrome may be the cause. Contact Balance Foot & Ankle in Southeast Michigan for evaluation with Dr. Biernacki.

Differential Diagnosis: What Else Could It Be?

Not every case of tarsal tunnel syndrome is straightforward. In our clinic we routinely rule out three look-alike conditions before confirming the diagnosis. If your symptoms don’t match the classic presentation, one of these may explain the pain — which is why physical exam matters more than self-diagnosis.

Condition	How It Differs
Plantar fasciitis	Sharp morning heel pain at the medial calcaneal tubercle, NOT numbness or shooting pain into the toes.
Diabetic peripheral neuropathy	Bilateral stocking-glove distribution, progressive, affects toes first — NOT reproduced by Tinel’s at medial ankle.
S1 radiculopathy	Pain originates in low back, follows S1 dermatome, positive straight-leg raise.

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Visit Balance Foot & Ankle — Same-Day Appointments Available

Our podiatry team serves patients throughout Michigan including Howell, Brighton, and Bloomfield Township. If you’re dealing with heel pain, ingrown toenails, or a foot injury, we have same-day appointment availability.