Tarsal Tunnel Syndrome (Posterior Tibial Neuralgia)

What is the Tarsal Tunnel?

The tarsal tunnel is an an anatomical tunnel in the ankle.
The flexor retinaculum is the roof of the tunnel with bone on the floor of the tunnel – the structures that pass through the tunnel include:
  • Posterior Tibial tendon
  • Tibial nerve
  • Posterior Tibial Artery
  • Posterior Tibial Vein
  • Flexor Digitorum Longus Tendon
  • Flexor Hallucis Longus Tendon
Tarsal tunnel ultrasound

Ultrasound examination at The Foot and Ankle Centre can assist in diagnosing this problem.

What is Tarsal Tunnel Syndrome (Posterior Tibial Neuralgia)?

Tarsal tunnel syndrome is a compression neuropathy of the posterior tibial nerve.

Posterior Tibial Nerve

Posterior Tibial Nerve

Depending on the area of entrapment, different areas of the foot can be affected. If the entrapment is high, the entire foot can be affected as varying branches of the tibial nerve are involved.

Posterior Tibial Nerve


Diagnosis of Tarsal Tunnel Sydrome

Diagnosis is generally made with specific signs and symptoms – when the pain occurs and the location. Burning, electrical sensations, and tingling over the base of the foot and the heel are common.

At the Ankle, Foot and Orthotic Centre we are able to provide additional information about the presence of Tarsal Tunnel Syndrome with ultrasound imaging. Typically someone with Tarsal Tunnel Sydrome will have a thicker tibial nerve as it passes in the tarsal tunnel

Tarsal Tunnel Ultrasound

This problem is commonly confused with plantar fasciitis and Achilles tendinopathy.

Tarsal tunnel Tibial nerve

Ultrasound image showing a thicker tibial nerve as at passes in the tarsal tunnel.

What causes Tarsal Tunnel Syndrome (Posterior Tibial Neuralgia)?

Compression of the tibial nerve is a result of compression in the tarsal tunnel. Compression can be a result of:

  • Trauma – trauma to the tarsal tunnel can result in swelling and irritation of the tibial nerve
  • Certain Connective tissue disorders
  • Biomechanical abnormalities- The main cause of irritation in the tarsal tunnel is Posterior TIbial Tendon Dysfunction from having an overly flat foot.  This is because the position of the foot changes the demand from certain muscle groups.
    Neutral Foot In a neutral foot  the muscles on the inside of the foot (invertors) work just as hard as the muscles on the outside of the foot (evertors).
    Flat Foot In a flat foot the muscles on the inside of the foot (invertors) work a lot harder to try and correct the position of the foot  – overtime this can result the degeneration of the tibialis posterior tendon and swelling in the tarsal tunnel.


Treatment of Tarsal Tunnel Syndrome (Posterior Tibial Neuralgia)?

The aim of treatment is to reduce the irritation of the tibial nerve, this is achieved by minimising the activity of the invertor muscles and tendons, and reducing the damage to the nerve. This can be achieve with:

  • Orthotics with a rearfoot post –There are a number of different orthotic designs available for flat feet. Most orthotic designs are simply arch supports.
    These are not ideal for the flat foot, often only irritating the arch of the foot.
  • Shockwave therapy
  • Surgery



The Ankle, Foot and Orthotic Centre’s Northcote Podiatrists can help you with all lower limb complaints, including tarsal tunnel syndrome. Make an appointment to get your foot and ankle pain under control.

Expert Podiatrists for the treatment of Tarsal Tunnel Syndrome servicing the areas of Northcote, Thornbury, Fitzroy, North Fitzroy, Carlton, North Carlton, Alphington, Fairfield, Brunswick, Coburg and Preston