Tarsal tunnel syndrome is an entrapment neuropathy of the posterior tibial nerve or its terminal branches as they pass into the foot through a fibro osseous tarsal tunnel below and behind the medial malleolus.

It presents with pain and paraesthesia, or numbness in the distribution of the posterior tibial nerve. The diagnosis generally requires a positive Tinel’s sign and positive electrophysiological studies.

In the athletic individual TTS tends to be associated with running, jumping or impact sports. It has been assossiated with tarsal coalitions, accessory muscles and planovalgus foot deformity.

Treatment includes conservative measures such as ice, anti inflammatory medication, orthotics and modified activity. Surgical decompression needs to include the entire distal tarsal tunnel. The timing of surgery is controversial, but there is a strong body of evidence to suggest that earlier decompression avoids permanent nerve damage and fibrosis.