Tarsal Tunnel Syndrome: Workup, Surgical Decompression, and Outcomes

Watch: Dr. Tom Biernacki, DPM

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

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Tarsal tunnel syndrome — compression of the posterior tibial nerve and its branches within the fibro-osseous tarsal tunnel posterior to the medial malleolus — is one of the most frequently misdiagnosed conditions in podiatric practice. The diagnosis requires careful clinical correlation because the electrophysiologic findings are often subtle and non-specific, and the symptoms overlap with plantar fasciitis, peripheral neuropathy, and lumbar radiculopathy.

Anatomy and Causes

The tarsal tunnel is formed by the flexor retinaculum medially and the posterior tibial cortex and sustentaculum tali laterally, transmitting the posterior tibial nerve along with the FHL, FDL, and posterior tibial tendons and the tibial artery and vein. The posterior tibial nerve divides within or just distal to the tunnel into the medial plantar, lateral plantar, and medial calcaneal branches. Compressive causes include: space-occupying lesions (ganglion cysts, lipomas, varicosities, accessory muscles — the most surgically correctable causes); hindfoot valgus producing stretch and compression; tenosynovitis of the adjacent tendon sheaths; and post-traumatic fibrosis after calcaneal fracture or medial ankle sprain.

Workup

Clinical findings include a positive Tinel’s sign over the tarsal tunnel (sensitivity ~55%, specificity ~70%), medial ankle and plantar foot paresthesias and burning pain, and nocturnal symptoms. EMG/NCV testing has high specificity (~85%) but poor sensitivity (~50%) — a normal EMG does not exclude tarsal tunnel syndrome. MRI is the single most valuable diagnostic study to exclude space-occupying lesions, identify accessory muscles, and evaluate tendon pathology within the tunnel. Diagnostic ultrasound can identify ganglion cysts, varicosities, and nerve hypertrophy at the compression site.

Surgical Decompression and Outcomes

Surgical tarsal tunnel release involves complete division of the flexor retinaculum under direct visualization, decompression of all three nerve branches (medial plantar, lateral plantar, medial calcaneal), excision of any space-occupying lesion, and external neurolysis of the posterior tibial nerve when perineural fibrosis is identified. Published outcomes show 70–85% good or excellent results when a specific anatomic cause (ganglion, lipoma, varicosity, or accessory muscle) is identified and removed. Outcomes are significantly less predictable for idiopathic tarsal tunnel syndrome without an identifiable compressive lesion — approximately 50–60% achieve meaningful improvement in this subgroup. Concurrent correction of hindfoot valgus deformity (MDCO) significantly improves results when valgus is a contributing factor. Dr. Biernacki at Balance Foot & Ankle performs comprehensive tarsal tunnel evaluation and surgical decompression. Call (810) 206-1402 for evaluation 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 Treatment in Michigan

Tarsal tunnel syndrome causes burning, tingling, and numbness in the foot. Our podiatrists provide thorough workups including nerve conduction studies and offer both conservative and surgical decompression options.

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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. Lau JTC, Daniels TR. Tarsal tunnel syndrome: a review of the literature. Foot Ankle Int. 2019;20(3):201-209.
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.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

More Tarsal Tunnel Syndrome Guides from Dr. Tom

• Tarsal Tunnel Syndrome: Anatomy, Electrodiagnosis, and Surgical Decompression
• Tibial Nerve Anatomy, Tarsal Tunnel Syndrome, and Surgical Decompression
• Tarsal Tunnel Syndrome: Posterior Tibial Nerve Compression and Surgical Decompression

Need treatment? Learn about in-office tarsal tunnel syndrome treatment at Balance Foot & Ankle, or call (810) 206-1402 for same-day appointments.