Nerve Compression at the Inner Ankle
Tarsal Tunnel Syndrome
Protection → Controlled Motion → Return to Function
What Tarsal Tunnel Syndrome Is
Tarsal tunnel syndrome is the foot's version of carpal tunnel: the tibial nerve gets compressed as it passes through a tunnel behind the bony bump on the inside of your ankle. It causes burning, tingling, numbness, or shooting pain in the sole of the foot and toes, often worse with standing, walking, or at night. It responds well to offloading, nerve mobility, and addressing foot mechanics.
- Primary — Nerve-compression pain — burning, tingling, or numbness in the sole and toes, often worse with activity or at night, with tenderness behind the inner ankle bone. This protocol is for it.
- Secondary — Other causes — numbness in a stocking pattern in both feet may be a systemic neuropathy (like diabetes), and back-related symptoms can mimic it; these need assessment.
Involved tissues: The tibial nerve where it passes through the tarsal tunnel behind the inner ankle bone, and the foot mechanics (especially overpronation) and structures that can crowd it.
Two pillars for tarsal tunnel: first, offload and calm the nerve — supportive footwear or an arch support to reduce the pronation that stretches and crowds the nerve, activity modification, and gentle nerve gliding; second, restore foot and ankle mechanics and strength, especially the arch-supporting muscles, so the tunnel isn't stressed. Give the nerve room, then fix the foot.
Offload the nerve, fix the foot
The tibial nerve runs through a tight tunnel behind your inner ankle, and a few things crowd it — most commonly a foot that overpronates (rolls in and flattens), which stretches and compresses the nerve, plus swelling or a space-occupying issue in the tunnel. So the plan is: first offload — a supportive shoe or arch support to control the pronation, activity modification to reduce the aggravating standing and walking, and gentle nerve gliding to keep the tibial nerve moving freely without irritating it. Then rebuild the foot: strengthen the arch-supporting muscles (the intrinsics and posterior tibialis) so the foot holds a better position and stops crowding the tunnel. If numbness is constant or a muscle is wasting, that's your cue to get assessed.
⚠️ Screen Before You Start — Get Assessed First If You Have:
- ●Constant numbness, or weakness/wasting of the foot muscles
- ●Numbness in both feet in a stocking pattern (possible systemic neuropathy)
- ●Symptoms clearly starting in the back and radiating down (possible sciatica)
- ●A hot, red, swollen ankle with fever
- ●Symptoms after an ankle fracture or significant trauma
This is education, not a diagnosis, and doesn't replace hands-on care.
🌡️ Finding your stage
Take your movement temperature. Frequent or nightly symptoms, easily provoked = Protection. Symptoms settling, only with prolonged standing/walking = Controlled Motion. Occasional, ready to build strength = Return to Function. The win is less burning and tingling, and more tolerance for standing and walking. Re-check every session.
Phase 1 · Acute
Protection Phase
🌡️ Frequent / nightly symptoms · easily provoked
Goal: Calm the nerve by offloading the foot and gliding gently.
Manual treatment: Pain-relief modalities and gentle, symptom-free nerve gliding.
Frequency: Daily · gentle sessions.
A. Calm & Offload
SoftWave Therapy
Video coming soon- Dose
- As scheduled
- How
- Applied to the inner ankle to calm the nerve and support healing.
- Watch for
- The anchor of the early phase.
Supportive Footwear / Arch Support
Video coming soon- Dose
- Ongoing
- How
- A supportive shoe or arch support to control pronation and offload the nerve.
- Watch for
- Controlling the pronation is one of the biggest early wins.
Activity Modification
Video coming soon- Dose
- Ongoing
- How
- Reduce prolonged standing and walking on hard surfaces.
- Watch for
- Cut back the standing/walking that flares it while it settles.
B. Gentle Nerve Glides
Tibial Nerve Glides
Video coming soon- Dose
- 1–2 × 5–10 gentle
- How
- Gentle glides to keep the tibial nerve sliding freely.
- Watch for
- Must NOT increase the burning or tingling — ease off if it does.
The biggest early wins are a supportive shoe/arch support to control pronation and reducing prolonged standing. Nerve glides gentle — must not increase symptoms.
✅ Ready for the next phase when:
Symptoms are less frequent, especially at night.
Tracking Your Progress
The weekly stability check: am I better, the same, or worse than last week?
Better
Stay the course; progress strength and tolerance as the burning/tingling fades.
Same
Change something — the footwear/support, the glides, or the arch strengthening.
Worse
Drop back and re-offload. If numbness turns constant or a muscle wastes, get assessed.
The Rules That Govern This Protocol
- 1Offload the nerve — supportive footwear/arch support and less prolonged standing.
- 2Keep the tibial nerve gliding gently, never into a flare.
- 3Strengthen the foot and arch so the tunnel isn't crowded.
- 4No lasting increase in numbness or burning after a session.
Movement You Love Is Therapy. This protocol is general education based on course rehabilitation materials and standard principles. It is not medical advice, diagnosis, or treatment, and does not create a provider–patient relationship. If pain is severe, worsening, or unexplained, see a licensed provider.