Tarsal tunnel syndrome is the foot’s version of carpal tunnel: the tibial nerve is squeezed as it runs behind the inside of the ankle under a tight ligament. Patients feel burning, electricity, or numbness in the heel, arch, or toes — often at night — and many of them have already been treated for plantar fasciitis that never quite fit.
Millennium Podiatry looks for the nerve when the fascia story has holes in it.
A tunnel of bone and the flexor retinaculum on the inside of the ankle contains the tibial nerve and several tendons. Swelling, a flat foot that collapses into the tunnel, a cyst, varicose veins, or scar from an old sprain can crowd that space. The nerve complains.
It is a different disease from peripheral neuropathy, which is usually both feet, stocking-distribution, and metabolic. You can have both. We will not treat one and ignore the other.
Bottom-of-heel pain that is only mechanical first-step pain is still fascia until the nerve exam says otherwise.
History plus a nerve-focused exam. We tap the tunnel, check sensation, and look at foot posture. Ultrasound can show a cyst. Nerve studies help when we need to separate tunnel compression from neuropathy or a higher lesion. We do not order every test on every patient; we order the one that changes the plan.
Custom orthotics that support a collapsing arch are first-line when pronation is the engine.
Activity changes, anti-inflammatory measures, and treatment of whatever is occupying the space.
A carefully placed injection can be both treatment and a diagnostic test — if the nerve quiets, we have the right zip code.
Release of the retinaculum, and removal of a cyst if there is one, is for patients who stay symptomatic after a complete non-surgical plan, or who have a clear mass. Dr. Shalot performs that surgery. It is not a casual add-on.
Conservative care has no downtime. After a release, expect a short period of protected walking and then nerve recovery that can continue for months. Nerves are slow correspondents.
Evaluation typically $200–$500. Nerve studies and ultrasound, if needed, are additional. Orthotics and injections are quoted after the exam. Surgical release is a separate fee. We check insurance.
Sometimes people have both. Pure night-time burning is not fascia.
If we decompress it before it is badly damaged, usually yes. Long-standing numbness is more guarded.
When the diagnosis is uncertain or we are planning surgery. Not as a first reflex.
