If you feel burning, tingling, or numbness along the inside of your ankle or on the bottom of your foot—especially after standing or walking—you might be dealing with tarsal tunnel syndrome. People sometimes call it “ankle carpal tunnel” because it involves a nerve being compressed in a tight space, much like carpal tunnel in the wrist.
Tarsal tunnel syndrome can make standing at work, walking around a store, or enjoying outdoor activities in Northeast Pennsylvania surprisingly miserable. The good news is that many cases respond well to conservative care, and physical therapy is a key part of that approach.
In this guide, we will cover:
- What tarsal tunnel syndrome is (and why it happens)
- Common symptoms and red flags
- How physical therapists evaluate ankle and foot nerve pain
- Specific ways PT can reduce symptoms and improve function
- Simple strategies to support healing at home
What Is Tarsal Tunnel Syndrome?
The tarsal tunnel is a narrow space on the inside of your ankle, formed by bones and a strong band of tissue. Several important structures pass through this tunnel, including the posterior tibial nerve. This nerve supplies sensation to the sole of the foot and helps control some of the small muscles there.
In tarsal tunnel syndrome, the posterior tibial nerve becomes irritated or compressed as it passes through this tunnel. That irritation can lead to:
- Burning or tingling pain
- Numbness or “pins and needles”
- Aching or shooting sensations
Because nerves carry both sensation and motor signals, long-standing compression can also affect muscle function and foot control if not addressed.
Common Causes and Risk Factors
Tarsal tunnel syndrome is usually not caused by just one thing. Often, several factors work together to irritate the nerve, including:
- Flat feet or overpronation: When the arch collapses and the ankle rolls inward, it can increase pressure on the structures in the tarsal tunnel.
- Swelling or inflammation: After a sprain, fracture, or overuse, swelling can crowd the tunnel.
- Tight structures: Tight calf muscles, restricted ankle joints, or stiff soft tissues can change how forces travel through the ankle and foot.
- Masses or space-occupying lesions: Occasionally, cysts, bone spurs, or varicose veins in the tunnel can add pressure.
- Repetitive stress: Long hours of standing, walking on hard surfaces, or high-impact exercise without adequate support.
Sometimes, no single “smoking gun” is obvious—but the way you stand, walk, and use your foot still plays a big role in how the nerve is loaded.
Signs and Symptoms of Tarsal Tunnel Syndrome
Everyone’s experience is a little different, but common symptoms include:
- Burning, tingling, or numbness along the inside of the ankle, heel, arch, or sole of the foot
- Pain that worsens with standing or walking and may ease with rest
- Shooting or electric-type pains into the bottom of the foot or toes
- Sensation changes (like walking on a “bunched-up sock” or “pebbles”)
- Occasional weakness or clumsiness in the foot if irritation has been present for a long time
Symptoms can be one-sided or affect both feet, but often one side is worse. Some people notice symptoms more at night, especially if they have been on their feet all day.
When to Seek Medical Attention
Most cases of tarsal tunnel syndrome are not emergencies, but you should seek prompt evaluation if you notice:
- Sudden, severe pain or rapidly worsening symptoms
- Significant weakness in the foot or difficulty controlling your toes
- Noticeable muscle wasting or dramatic loss of sensation
- Symptoms after a major injury to the ankle or foot
Your healthcare provider can rule out fractures, serious nerve damage, or other conditions that might require additional testing or medical management. Physical therapy is often part of the conservative treatment plan, whether or not further testing is done.
How Physical Therapy Evaluates Tarsal Tunnel Syndrome
At Cawley Physical Therapy & Rehabilitation, a tarsal tunnel evaluation is more than just checking where it hurts. Your therapist will look at how the entire leg and foot are working together.
History and Symptom Pattern
Your therapist will ask questions such as:
- Where exactly do you feel symptoms, and what do they feel like?
- Do symptoms change with walking, standing, or rest?
- Did they start gradually or after an injury?
- What kind of shoes do you wear most often?
- What are your work duties, sports, and daily activities?
This helps determine whether your symptoms fit a nerve compression pattern and what may be aggravating it.
Physical Examination
A typical exam may include:
- Palpation: gently pressing along the inside of the ankle and along the nerve pathway to identify tender spots.
- Range of motion: checking mobility of the ankle, subtalar joint, and toes.
- Strength testing: looking at muscles that support the arch, ankle, and hip.
- Foot posture and gait analysis: assessing how your foot and ankle move when you stand, walk, or run.
- Neural tension or glide tests: gentle positions that stress the nerve slightly to see how it responds.
The goal is to identify both the irritated tissue and the contributing movement or posture patterns that keep stressing it.
If ankle or foot nerve pain is starting to limit your walking, standing, or work, early help can prevent it from becoming a long-term issue.
Contact Us today for a free pain assessment
How Physical Therapy Helps Tarsal Tunnel Syndrome
Physical therapy focuses on creating more space and better conditions for the nerve, while improving overall ankle and foot mechanics.
1. Reducing Irritation and Swelling
Early on, your therapist may help you find ways to calm the nerve and surrounding tissues:
- Activity modification to reduce prolonged standing or high-impact loading
- Positioning to avoid excessive inward rolling of the ankle
- Guidance on the use of ice or gentle compression around the area (as appropriate)
The goal is not to immobilize you completely, but to find the “sweet spot” where you are moving enough to stay healthy without repeatedly aggravating the nerve.
2. Improving Foot and Ankle Alignment
If your ankle rolls inward or your arch collapses, the tissues in the tarsal tunnel may be under more pressure. PT can help by:
- Teaching better weight-bearing and alignment strategies
- Using taping techniques to support the arch and reduce stress on soft tissues
- Discussing footwear choices that provide adequate support and room in the toe box
In some cases, your therapist may suggest talking with your provider about inserts or braces, especially if your foot structure contributes strongly to symptoms.
3. Stretching Tight Structures
Tight muscles and connective tissues can limit movement and increase strain through the tunnel. Your program may include:
- Calf stretches (both with the knee straight and bent)
- Gentle stretches for the Achilles tendon and plantar fascia
- Mobility work for the ankle joint if it is stiff
These stretches are introduced carefully and progressed based on your tolerance and response.
4. Strengthening Key Muscles
Strengthening helps support the arch and ankle so the nerve is not overloaded with every step. Common targets include:
- Intrinsic foot muscles: small muscles in the foot that help support the arch.
- Posterior tibialis: a key muscle that supports the inner ankle and arch.
- Calf muscles: to improve push-off and reduce strain on supporting structures.
- Hip and core muscles: to control leg alignment from top to bottom.
Exercises might look like:
- Towel curls or picking up objects with the toes
- Resisted ankle inversion and eversion with a band
- Heel raises, progressing from both legs to single-leg as tolerated
- Hip abduction, bridges, and other functional strengthening drills
The specific choices depend on your strength, symptoms, and goals.
5. Nerve Glides and Mobility
Gentle nerve-gliding exercises can help the posterior tibial nerve slide more freely through the tunnel without being forced or overstretched. These are done carefully and usually later in treatment, once irritation has calmed.
Your therapist will show you how to:
- Move the ankle and foot through specific patterns while keeping symptoms mild
- Recognize the difference between a gentle “nerve stretch” and sharp, electric pain (which should be avoided)
Nerve glides are never about “stretching the nerve as far as possible”—they are about restoring smooth, comfortable movement.
6. Gait and Activity Retraining
Physical therapy also looks at how you:
- Walk and stand throughout the day
- Navigate hills, stairs, or uneven ground
- Perform job-related tasks that keep you on your feet
Your therapist may help you adjust step length, foot placement, or pace, and gradually reintroduce activities like longer walks, light jogging, or recreational sports when appropriate.
Practical At-Home Strategies to Support Healing
In addition to your in-clinic sessions, small changes at home and work can make a big difference.
Footwear Choices
- Choose shoes with good arch support and cushioning.
- Avoid very worn-out soles or shoes that tilt inward.
- Make sure there is enough room for your toes without compressing the forefoot.
- Consider having a “work pair” and “home pair” that both support your feet well.
Activity Pacing
- Break long periods of standing into shorter bouts when possible.
- Alternate tasks that involve standing with ones that allow you to sit briefly.
- Gradually increase walking distance rather than making big jumps in activity.
Daily Mobility and Strength Routine
- Perform your prescribed stretches and exercises regularly, not just when symptoms flare.
- Take brief “movement breaks” if you sit for long stretches, as stiff hips and calves can affect ankle mechanics.
If any home exercise consistently increases your pain beyond mild, short-lived discomfort, it is a sign to adjust that exercise or talk with your therapist.
If you live in Northeast Pennsylvania and are struggling with foot and ankle nerve pain, a focused PT program can help you walk more comfortably again.
Contact Us today for a free pain assessment.
Tarsal Tunnel Care at Cawley Physical Therapy in NEPA
At Cawley Physical Therapy & Rehabilitation, we understand how frustrating it is when every step hurts or tingles. Our approach to tarsal tunnel syndrome includes:
- A thorough evaluation of your foot, ankle, leg, and overall movement
- A clear explanation of what is happening and what you can do about it
- A customized plan that blends manual therapy, exercise, and activity modification
- Attention to your specific shoes, work environment, and daily demands
- Progress checks to make sure you are moving toward your goals, not just “getting by”
Whether you are on your feet all day for work, love walking local trails, or simply want to stand in the kitchen without burning foot pain, we aim to help you get back to what you enjoy with more comfort and confidence.
Frequently Asked Questions About Physical Therapy for Tarsal Tunnel Syndrome: Ankle Carpal Tunnel Explained
1. How is tarsal tunnel syndrome different from plantar fasciitis?
Both conditions can cause pain in the foot, but they involve different tissues and often feel different. Plantar fasciitis typically causes sharp, stabbing pain at the bottom of the heel, especially with the first steps in the morning or after sitting. Tarsal tunnel syndrome involves irritation of a nerve and is more likely to produce burning, tingling, numbness, or electric-type pain along the inside of the ankle and into the sole of the foot. Some people unfortunately have elements of both. A careful physical therapy or medical exam can usually tell which structures are driving your symptoms so your treatment plan is more precise and effective.
2. Can physical therapy actually fix tarsal tunnel syndrome, or will I always have symptoms?
Many people experience significant improvement or complete resolution of symptoms with conservative care, which often includes physical therapy. PT can help by reducing pressure on the nerve, improving foot and ankle alignment, calming irritated tissues, and strengthening supporting muscles so the nerve is not overloaded with each step. That said, every situation is unique. Factors such as the underlying cause, how long symptoms have been present, and overall health affect recovery. Some individuals may have occasional mild flare-ups during higher activity, while others regain full comfort and function. Surgery is typically reserved for cases where conservative treatment has not provided adequate relief or when a clear structural problem needs to be addressed.
3. How long does it take to feel better with physical therapy for tarsal tunnel syndrome?
Recovery timelines vary. Some people notice improvement within a few weeks of targeted therapy and activity changes, especially if symptoms are relatively new and mild. For others—especially when pain has been present for months or there are multiple contributing factors—progress may take several months of consistent work. The nervous system can be slow to calm down once it has become irritated. A good physical therapy plan will set realistic goals, check in regularly about your progress, and adjust exercises and strategies based on how you respond. The aim is steady, sustainable improvement rather than a quick fix that does not last.
4. Is it okay to keep walking or exercising if I have tarsal tunnel syndrome?
In many cases, you do not need to stop all activity, but you do need to be strategic. Completely resting for long periods can lead to stiffness and weakness, while pushing through intense pain can further irritate the nerve. The goal is “relative rest”: modifying activities that clearly worsen symptoms while staying as active as you safely can. That might mean reducing standing time at work, swapping high-impact exercise for lower-impact options, or breaking walks into shorter segments. Your physical therapist can help you figure out which activities are okay, which need to be adjusted, and how to gradually build back up as symptoms improve.
5. Will I need surgery for tarsal tunnel syndrome?
Most people with tarsal tunnel syndrome do not need surgery. Conservative treatments—such as physical therapy, footwear modifications, activity changes, and sometimes medication—often provide meaningful relief. Surgery is generally considered when symptoms are severe, persistent, and clearly related to a specific compressive structure that has not responded to non-surgical care. Even if surgery is recommended, physical therapy still plays an important role in preparing tissues beforehand and supporting recovery afterward. The best approach is to start with a thorough evaluation and a solid conservative plan; if progress stalls, your therapist and medical provider can discuss whether further testing or consultation with a specialist is appropriate.