There are a variety of things that can bring on ankle pain. Maybe you twisted or sprained it, or perhaps its arthritis at the ankle joint that’s flaring up. Or, it could be a lesser-known condition called tarsal tunnel syndrome. If the name makes you think of carpal tunnel syndrome in the hands, it’s a smart association. Tarsal tunnel syndrome is a very similar experience only it’s taking place in your ankle, causing a pins-and-needle feeling that can be uncomfortable.

The good news: Most of the time, tarsal tunnel syndrome resolves on its own with simple at-home treatments, including ankle strengthening and stretching exercises, says Sarah Kellen, PT, DPT, a physical therapist at Hinge Health.

Read on to learn more about tarsal tunnel syndrome, what causes it, and which PT-recommended exercises can help you feel better, faster.

What Is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is an irritation, or compression, of the nerve that runs through the tarsal tunnel inside the ankle, says Dr. Kellen. Your tarsal tunnel is literally a tunnel: It’s a very narrow channel through which the posterior tibial nerve runs. “Like carpal tunnel syndrome, this condition occurs due to nerve compression in a very tight space,” explains Dr. Kellen.

If you develop tarsal tunnel syndrome, all it means is that your tarsal tunnel has become narrower than usual. “When the nerve is compressed in the narrower tunnel, it becomes sensitive leading to ankle pain, tingling, or numbness,” says Dr. Kellen.

Tarsal Tunnel Syndrome Symptoms

How do you know if your discomfort is due to your tibial nerve, or something else entirely? With tarsal tunnel syndrome symptoms, the pain is usually on the inside of your ankle and the sole of your foot, says Dr. Kellen. Other signs include:

• Tingling, burning, or an “electric shock” sensation. “It can occur in just one spot, or radiate down to your foot, or even up into your calf,” says Dr. Kellen. “Unlike sciatica pain, which starts in your glutes and radiates down your leg to your toes, this is more localized in your ankle and foot.”

• Numbness. 

• Pain that’s made worse if you stand or walk for a long period of time.

Tarsal Tunnel Syndrome: A Hinge Health Perspective

Learning about conditions that cause pain can be alarming. We know from Hinge Health members and research studies that anatomical labels can backfire when it comes to your treatment and recovery. When people hear they may have a condition like tarsal tunnel syndrome, it can cause feelings of panic, like you have something "wrong" that needs to be fixed. This way of thinking about pain is largely outdated.

For most common musculoskeletal conditions, regardless of what may or may not be contributing to pain in your tissues, the solution is often the same. Movement — through physical and exercise therapy — can reduce pain because it gets your tibial nerve moving and gliding again, reassures Dr. Kellen. “It also helps to strengthen your ankles to prevent future flare-ups.” 

And even if your tibial nerve pain needs time to recover, you can still keep up your aerobic capacity — and increase blood flow to the area — with no- or low-impact cardiovascular training like biking or swimming, says Dr. Kellen. You can also do ankle and lower leg strengthening and stretching exercises (like the ones recommended below) to increase strength and flexibility in the area.

Common Causes of Tarsal Tunnel Syndrome

Tarsal tunnel syndrome happens when your tibial nerve becomes irritated. Some things that can contribute to this include:

• Foot anatomy. If you have flat feet or, in some cases, very high arches, you’re more likely to develop tarsal tunnel syndrome. “Anything that causes overpronation, which causes your ankles to turn inwards, puts more pressure on your tibial nerve,” explains Dr. Kellen.

• Varicose veins. These bulging, enlarged veins can put pressure on the tibial nerve, causing symptoms, and they’ve been shown to be a fairly common cause of tarsal tunnel syndrome. Other culprits include ganglion cysts and bone spurs.

• Ankle injury. Over 40% of people with tarsal tunnel syndrome have a history of ankle injuries. The inflammation and swelling from an injury, such as an ankle sprain or fracture, can cause compression of the tarsal tunnel nerve, says Dr. Kellen.

• Underlying medical conditions. Diseases such as type 2 diabetes, arthritis, or even hypothyroidism can cause swelling in your feet and ankles, which puts pressure on the tarsal tunnel nerve.

• Going beyond your body’s movement sweet spot. Tarsal tunnel syndrome can occur due to repetitive stress on your ankles, especially if you engage in more exercise than your body is ready for, like ramping up running mileage too quickly. “We see this in a lot of runners if they develop tendinitis that compresses their posterior tibial nerve,” explains Dr. Kellen. 

While some of these factors may be out of your control, there’s still a lot you can do to manage any pain or discomfort you’re feeling. 

Treatment Options for Tarsal Tunnel Syndrome

Most people can manage tarsal tunnel syndrome at home with conservative treatments, says Dr. Kellen. These include:

• Activity modifications. If your tarsal tunnel is irritated by certain activities, like running or walking, Dr. Kellen recommends that you switch things up. She often suggests shortening the activity, taking breaks, or finding a different route that might change the stress on the nerve. In some cases, she might even suggest temporarily switching to less weight-bearing activities. This includes swimming, cycling, and even the elliptical. “As your symptoms improve, you’ll gradually build back to doing the movements you love at your pre-injury activity levels,” she says.

• Over-the-counter medications. Pain relievers such as ibuprofen (Advil, Motrin) or naproxen (Aleve) can be helpful to relieve nerve inflammation and pain. It’s important to make sure that you’re safely able to take them, based on your medical history. Another option is an over-the-counter non-steroidal anti-inflammatory cream, like diclofenac (Voltaren).

• Ice. While you can use either ice or heat, Dr. Kellen says people often find the most relief with ice, as it helps to reduce inflammation. If you have non-inflammatory tarsal tunnel pain, heat may be preferred. 

• Physical therapy. A physical therapist (PT) can show you exercises to help strengthen ankle muscles in order to take pressure off your tibial nerve, says Dr. Kellen. These include nerve gliding exercises to stretch out your tibial nerve. Your PT can also examine your foot anatomy and your gait to offer suggestions on how to improve both if they also are contributing to your nerve pain. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Orthotics and footwear changes. These changes may be recommended for people with flatter feet, or more severe symptoms, says Dr. Kellen. “New footwear or orthotics can provide arch support, which can take pressure off a sensitive tibial nerve and ankle,” says Dr. Kellen. “They can also control pronation, or your foot rolling inward, which can irritate the affected nerve.” In rare cases, a clinician might temporarily suggest a brace or boot to keep your foot in place and reduce pressure on the tibial nerve if other strategies don’t provide enough relief. 

These exercises are recommended by Hinge Health physical therapists to support healing if you’re experiencing tarsal tunnel syndrome. They generally help keep your ankle muscles strong and flexible. Nerve compression can also cause weakness in your ankle muscles, so you want to make sure you strengthen them to prevent re-injury, adds Dr. Kellen.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Warm Up Your Ankles Before a Workout

A proper warm-up is recommended before exercising and, when it comes to tarsal tunnel syndrome, you want to focus on increasing blood flow to your ankle area to help your tibial nerve move more smoothly, advises Dr. Kellen. Warm-up exercises also help keep your ankles strong, which takes strain off the tarsal tunnel. 

Warming up can be as easy as starting your activity of choice at a lower intensity, like jogging slowly before your run. If you have time, adding specific ankle exercises into the mix, like walking on your toes, walking with high knees in place, side stepping left and right, or doing any of the exercises above, can be a great warm-up for your feet and ankles.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Fortier, L. M., Leethy, K. N., Smith, M., McCarron, M. M., Lee, C., Sherman, W. F., Varrassi, G., & Kaye, A. D. (2022). An Update on Posterior Tarsal Tunnel Syndrome. Orthopedic Reviews, 14(3). doi:10.52965/001c.35444

2. Rutkove, S. B. (2024, January 2). Overview of lower extremity peripheral nerve syndromes. UpToDate. https://www.uptodate.com/contents/overview-of-lower-extremity-peripheral-nerve-syndromes 

3. Kiel, J., & Kaiser, K. (2019, February 4). Tarsal Tunnel Syndrome. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513273/ 

4. Herring, M., Green, T., Pourciau, K., Morton, C., & Lowry, Jr., W. J. (2019). Tarsal Tunnel Syndrome and the Relevance of Electrodiagnostic Studies in Treatment Planning. American College of Foot and Ankle Surgeons. https://www.acfas.org/getattachment/27abfb52-f54b-4697-8ece-83751ae963a1/POST2019_SCI-705.pdf?lang=en-US