Not all heel pain is plantar fasciitis. Tarsal tunnel syndrome is a pinched nerve at the ankle. The posterior tibial nerve gets squeezed as it runs through the tarsal tunnel, a narrow passage on the inside of the ankle. The research calls it an underdiagnosed cause of heel pain and foot trouble.1 If months of stretching, shoe inserts and rest have not helped, rethink the diagnosis. Do not just repeat it.
What the tarsal tunnel contains
The tarsal tunnel holds the tibial nerve, the posterior tibial artery, and three tendons: tibialis posterior, flexor digitorum longus and flexor hallucis longus.1 When the tibial nerve gets squeezed in that space, it causes pain, numbness, tingling and weakness along the nerve’s path.1
Those last three symptoms are the tell. Plantar fasciitis is a tissue problem, and it hurts. It does not usually cause numbness, tingling or weakness. When those show up, a nerve is involved.
Why it takes so long to identify
The signs vary from person to person, because there are many possible causes and many parts in play. Symptoms may creep in slowly over months to years, or start after an injury.1
Worse, there is no clear-cut exam test or scan for it. That often delays the diagnosis. The delay leads to worse results and less success with treatment.1 A scan does not reliably settle this. That is exactly why it slips through.
Delay has a cost
In severe or long-standing cases, the nerve may be damaged for good if it is left untreated.1 The review is clear: early diagnosis and early treatment are key. They help you avoid lasting nerve injury and get the most from care, whether conservative (non-surgical) or surgical.1
That changes the math on waiting. With plantar fasciitis, waiting and watching is fine. With a squeezed nerve, time works against you.
How the question gets answered
No single test settles it. So we combine the symptom pattern with tests that measure nerve function directly. Nerve conduction studies and electromyography (EMG) check whether the tibial nerve carries signals normally. No ultrasound or X-ray can tell you that.
That testing is covered under electrodiagnostic testing. Foot and ankle pain in general is covered under foot pain. When a nerve is trapped in scar or nearby tissue, hydrodissection is one of the options. When diabetes is part of the picture, see diabetes and neuropathy .
Frequently asked questions
How do I know my heel pain is not plantar fasciitis?
Numbness, tingling or weakness along with the pain points to a nerve, not the fascia. That is because tarsal tunnel syndrome squeezes the tibial nerve. See foot pain.
Why has no scan shown anything?
There is no clear-cut exam test or scan for this condition. That is one of the main reasons the diagnosis gets delayed. Nerve function has to be measured, not pictured. See electrodiagnostic testing.
Can it come on without an injury?
Yes. Symptoms may creep in over months to years, or start after an injury. Either pattern fits the diagnosis. Our exam is described on the pain treatments page.
Is it safe to keep waiting to see if it settles?
Not forever. In severe or long-standing cases, the nerve can be damaged for good if untreated. Early treatment is key to avoiding lasting nerve injury. Set up an exam through the appointment request form.
Does this have anything to do with diabetes?
It can, because nerve vulnerability and neuropathy (nerve damage) change the picture and the treatment plan. See diabetes and neuropathy.
To have lasting heel pain checked, request an appointment, call (314) 481-5000, or text (314) 886-5902.
Sources
- Sha I I. Tarsal Tunnel Syndrome — A Comprehensive Review. The Iowa Orthopaedic Journal. 2024;44(2):32–36. Retrieved via PubMed. PMC11726481
Dr. Gurpreet Singh Padda, MD, MBA, MHP
