Burning under the arch. Pins and needles across the sole. A numb patch under the toes that seems to arrive after a long day on your feet and then keeps you awake at night. You may have been told it is plantar fasciitis, done the stretches and the rolling, and found that nothing much changed. There is a reason for that: heel pain from the fascia does not usually burn or tingle. Nerves do.
Tarsal tunnel syndrome is the foot's version of carpal tunnel syndrome, and it is one of the most commonly missed causes of sole-of-foot pain we see in podiatry at ACE Sports Medicine. This article explains what it is, how to tell it apart from fascia pain, and the conservative care that helps most people.
In this article
What is tarsal tunnel syndrome?
Behind the bony bump on the inside of your ankle there is a narrow tunnel. Its floor is bone and its roof is a tough band of tissue called the flexor retinaculum. Through that tunnel run three tendons, an artery, a vein and the tibial nerve, which goes on to supply feeling and muscle control to the sole of the foot. When the space inside the tunnel gets crowded, the nerve is compressed, and the result is burning, tingling, shooting or numb sensations in the arch and sole, sometimes tracking up the inside of the leg. Symptoms are typically worse after prolonged standing or walking, and often worse at night.
It is uncommon compared with carpal tunnel syndrome, and it is frequently misdiagnosed, most often as plantar fasciitis or as a general neuropathy. That is why it tends to drag on for months before it is correctly named.
If your foot pain has not behaved like it "should", our podiatry in Mount Gravatt team can assess the nerve as well as the fascia.
Who gets it and why?
Who it affects
Women are about three times more likely than men to develop it, peak onset is between 40 and 60, and between 17% and 43% of people report a previous ankle injury such as a sprain or fracture. Flat feet and over-pronation, swelling, cysts, varicose veins, poorly fitting footwear, diabetes and inflammatory arthritis are among the recognised contributors.
That 80% figure matters because it changes how the problem is approached. Tarsal tunnel syndrome is rarely "just one of those things". A foot that rolls in and stretches the nerve with every step, an old ankle sprain that left scarring or swelling in the tunnel, or a small cyst pressing on the nerve are all findable, and each points to a different plan.
Burning or tingling that the stretches have not touched? A podiatry assessment at ACE Sports Medicine in Upper Mount Gravatt looks at the nerve, the foot posture and the footwear together.
Nerve or fascia: how do you tell the difference?
Plantar fasciitis is classically a sharp heel pain with the first steps in the morning that eases as you warm up. Tarsal tunnel syndrome behaves differently. The sensations are burning, tingling, electric or numb rather than a dull ache. They sit in the arch and the sole, not just the heel, and can spread toward the toes or up the inside of the shin. They build with time on your feet rather than being worst first thing, and they frequently intrude at night. Pressing behind the inside ankle bone, rather than under the heel, is often tender.
Because the two can coexist, and because nerve symptoms in the feet can also come from the lower back or from conditions like diabetes, the assessment is about narrowing it down rather than ticking one box.
The tests a podiatrist uses
The diagnosis is mostly made in the room. A gentle tap over the tunnel behind the inside ankle bone that sends tingling into the sole is called a positive Tinel's sign. Holding the foot pulled up and turned outward for about ten seconds, which stretches the nerve through the tunnel, reproduces symptoms in about 82% of people with the condition, and is one of the more reliable tests we have. Your podiatrist will also look at your arch and how you walk, check sensation and strength in the small muscles of the foot, and examine the footwear you spend most time in.
Imaging and nerve conduction studies are sometimes used to look for a specific cause inside the tunnel or to rule out other conditions, but a normal test does not exclude tarsal tunnel syndrome, and most people do not need one to start treatment.
What actually helps?
Conservative care comes first, and the evidence supports that. In a 2026 study following 76 conservatively treated feet for at least five years, 65% had a satisfactory outcome, results were better in women, and the authors concluded that conservative treatment should be first-line even when a scan shows contact with the nerve. The aim is to take the strain off the nerve: footwear with proper support, an orthosis or medial heel wedge that reduces the roll-in that stretches the tunnel with every step, strengthening the tibialis posterior muscle that holds the arch up, calf stretching, nerve-gliding exercises, and a sensible look at how much standing and walking the foot is being asked to do while it settles. Where swelling or inflammation is part of the picture, your podiatrist may discuss medication or an injection with your GP.
For the minority who do not improve, or where a specific cause such as a cyst is found, surgical release of the tunnel is an option; reported success rates vary widely, from 44% to 96%, and are best when there is a clear cause and an early diagnosis. That last point is the practical takeaway: the sooner the nerve is named as the problem, the better every option tends to work.
When should you seek help?
Sole-of-foot symptoms that burn, tingle or go numb are a nerve pattern, and they are worth assessing rather than waiting out.
Consider getting assessed if
You have burning, tingling, electric or numb sensations in the arch or sole; they build with standing or walking and disturb your sleep; "plantar fasciitis" treatment has not helped; the area behind your inside ankle bone is tender; your foot rolls in, you have flat feet, or you have had an ankle sprain or fracture in the past; or you have diabetes or an inflammatory condition. Weakness in the toes, a visible change in the shape of the foot, or numbness that is spreading need prompt assessment.
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Helping You Perform at Your Best
Our podiatry team at ACE Sports Medicine in Upper Mount Gravatt assesses nerve-related foot pain for people across Brisbane's southside, from the runner with a rolling arch to the person whose "heel pain" has never behaved like heel pain. Naming the nerve is usually the turning point, and conservative care helps most people.