Richmond & Kensington, London
Tarsal Tunnel Syndrome
Treatment in Richmond & Kensington
Burning, tingling or shooting pain in the foot? Expert assessment and evidence-based treatment for tarsal tunnel syndrome by HCPC-registered podiatrists.
HCPC Registered
Nerve Assessment
Injection Therapy Available
No Referral Needed
Tarsal tunnel syndrome is a nerve entrapment condition caused by compression of the posterior tibial nerve — or one of its branches — as it passes through the tarsal tunnel, a narrow channel on the inside of the ankle. This compression causes pain, tingling, burning or numbness that can radiate into the heel, arch and toes.
It is the foot's equivalent of carpal tunnel syndrome in the wrist. Though less widely known, tarsal tunnel syndrome is an important cause of chronic foot and ankle pain — particularly in runners and people with flat feet. Accurate diagnosis is essential, as it is frequently confused with plantar fasciitis or other heel pain conditions, and the treatment approach differs significantly.
The Tarsal Tunnel
The tarsal tunnel is a narrow passageway on the inner side of the ankle, bounded by bone on one side and a thick ligament (the flexor retinaculum) on the other. Running through it are the posterior tibial nerve, two tendons and blood vessels.
When the space within the tunnel becomes reduced — due to swelling, a structural deformity, a space-occupying lesion or abnormal foot mechanics — the posterior tibial nerve becomes compressed, producing the characteristic symptoms of tingling, burning and pain radiating into the foot.
Common Causes
Flat feet or excessive pronation
Swelling from ankle sprains or injury
Varicose veins near the tunnel
Ganglion cysts or lipomas
Tight or restrictive footwear
Systemic conditions (diabetes, arthritis)
Post-surgical scarring near the ankle
Increased training load in runners
How It Feels
Burning or shooting pain on the inner ankle
Tingling or pins and needles in the heel or toes
Numbness along the sole of the foot
Pain radiating into the arch or heel
Symptoms worse with prolonged standing or walking
Pain at rest or at night in more severe cases
Weakness in foot muscles (advanced cases)
A Key Clinical Sign
A positive Tinel's sign — a tingling or electric sensation produced by tapping lightly over the tarsal tunnel — is a hallmark clinical finding of nerve compression at this site.
Symptoms often worsen with activity and improve with rest, though in more chronic or severe cases pain may persist at rest or disturb sleep. The distribution of symptoms depends on which branch of the posterior tibial nerve is affected.
Several conditions cause medial ankle and heel pain with or without nerve symptoms. Accurate diagnosis before treatment is essential.
Plantar Fasciitis
Causes inferior heel pain on the plantar surface, typically worst in the morning. No tingling or burning — the absence of neurological symptoms helps distinguish it from tarsal tunnel syndrome.
Baxter's Nerve Entrapment
Compression of a specific branch of the posterior tibial nerve causing medial heel burning. Sometimes considered a subtype of tarsal tunnel syndrome. Distinguished by the precise location of symptoms and nerve provocation tests.
Peripheral Neuropathy
Systemic nerve damage (commonly from diabetes) causing bilateral burning or tingling in the feet. Unlike tarsal tunnel syndrome, symptoms are typically symmetrical and not provoked by a specific anatomical compression point.
Tibialis Posterior Tendinopathy
Pain and tenderness along the inner ankle from tendon overload. Produces medial ankle pain similar in location to tarsal tunnel syndrome but without the characteristic neurological symptoms of burning, tingling or numbness.
We take an evidence-based, conservative-first approach to tarsal tunnel syndrome. The majority of cases respond well to non-surgical management — particularly when the underlying biomechanical and mechanical contributors are identified and addressed early. Treatment is always personalised to your specific presentation, the severity of nerve compression and your activity goals.
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Accurate Diagnosis & Assessment
A thorough clinical examination including Tinel's sign, nerve tension tests and assessment of foot and ankle mechanics. Where nerve conduction studies or imaging are clinically indicated, we will refer you appropriately. Getting the diagnosis right is the most important step — tarsal tunnel syndrome is frequently mismanaged when confused with plantar fasciitis.
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Custom Orthotics
For patients with flat feet or excessive pronation — common drivers of tarsal tunnel compression — custom orthotics prescribed following your gait assessment can reduce the mechanical stress on the tarsal tunnel and provide significant symptom relief. Prescribed following treadmill analysis with Onform joint tracking.
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Nerve Mobilisation Exercises
Specialised neural mobilisation exercises help reduce nerve tension, improve nerve mobility within the tunnel and decrease hypersensitivity. These are an important component of tarsal tunnel rehabilitation and are prescribed as part of a structured home exercise programme.
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Strengthening & Rehabilitation
Targeted exercises to strengthen the intrinsic foot muscles, improve ankle and lower limb control, and address any movement patterns contributing to nerve compression. Combined with nerve mobilisation for best results.
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Soft Tissue Therapy & Joint Mobilisation
Hands-on treatment to reduce muscle tightness around the tarsal tunnel, improve joint mobility in the ankle and foot, and decrease compression on the posterior tibial nerve. Particularly useful in the early stages to reduce pain and improve comfort.
06
Footwear & Activity Advice
Tight or restrictive footwear can directly compress the tarsal tunnel and worsen symptoms. We advise on appropriate footwear with adequate width and depth at the ankle, and on activity modifications to reduce nerve irritation while maintaining fitness.
07
Corticosteroid Injection
A targeted steroid injection into the tarsal tunnel can provide significant pain relief in cases with significant inflammation or when conservative measures alone are insufficient. Used selectively and as part of a broader treatment plan — not as a standalone solution. See our
injection therapy page for more information.
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Surgical Referral (If Required)
If conservative management does not produce adequate improvement, surgical decompression of the tarsal tunnel may be considered. Where this is appropriate we will refer you to a trusted orthopaedic or podiatric surgeon within our network and coordinate your pre- and post-operative care.
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Accurate differential diagnosisWe distinguish tarsal tunnel syndrome from plantar fasciitis, peripheral neuropathy and other conditions before treating.
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Treadmill gait analysis with OnformIdentifying the biomechanical contributors to nerve compression — particularly flat feet and pronation patterns.
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Injection therapy availableTargeted corticosteroid injections for cases with significant inflammation — used selectively and alongside rehab.
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Nerve mobilisation expertiseStructured neural mobilisation programme to improve nerve movement and reduce hypersensitivity.
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Surgical referral networkCoordinated referral to trusted surgeons if conservative management is insufficient.
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HCPC-registered podiatristsRichmond (TW9) and Kensington (W8) — no GP referral needed.
How is tarsal tunnel syndrome different from plantar fasciitis?
The key difference is the presence of neurological symptoms — burning, tingling, pins and needles or numbness — which are characteristic of nerve compression and are not features of plantar fasciitis. Both conditions can cause medial heel pain, but the distribution, quality and provocation of symptoms differs. A clinical assessment with nerve tension and provocation tests is essential to distinguish between them.
Do I need nerve conduction studies?
Not always. Many cases of tarsal tunnel syndrome can be diagnosed clinically without electrodiagnostic testing. Nerve conduction studies are most useful in complex or atypical presentations, when surgery is being considered, or when the diagnosis remains uncertain after clinical assessment. We will advise on whether investigation is indicated at your appointment.
Can tarsal tunnel syndrome be cured without surgery?
Yes — the majority of cases respond well to conservative management, particularly when the underlying cause is identified and addressed. Orthotics for flat feet, nerve mobilisation exercises, footwear changes and injection therapy where appropriate produce good outcomes in most patients. Surgery is reserved for cases that do not respond to a thorough course of conservative treatment.
How long does treatment take?
This depends on the severity and duration of symptoms. Mild to moderate cases with a clear biomechanical contributor often improve within 6–12 weeks with the right treatment. Long-standing cases or those with a structural cause such as a cyst may take longer or require additional investigation. We will give you a realistic timeline at your assessment.
Can flat feet cause tarsal tunnel syndrome?
Yes — flat feet or excessive pronation is one of the most common biomechanical contributors to tarsal tunnel syndrome. When the foot rolls inward excessively, it stretches and compresses the structures within the tarsal tunnel. Addressing foot mechanics with orthotics and strengthening is an important part of long-term management for these patients.
Is treatment covered by health insurance?
Yes — podiatry consultations and injection therapy are typically covered by most major insurers. We work with Bupa, Aviva, WPA and others. See our
Insurance page for full details.
Book your tarsal tunnel assessment today
Richmond and Kensington clinics available. No referral needed.
