Tarsal Tunnel Syndrome Testing in Sydney
Same-day nerve conduction studies for posterior tibial nerve compression — Dr Ron Granot, FRACP, Bondi Junction
Book Your Test NowWhat is Tarsal Tunnel Syndrome?
Tarsal tunnel syndrome is the foot's equivalent of carpal tunnel syndrome. The posterior tibial nerve — which supplies sensation to the sole of the foot and powers some of the small foot muscles — passes through a narrow fibro-osseous channel behind the medial malleolus (the bony bump on the inside of the ankle). When something compresses or irritates the nerve in that channel, the result is burning, tingling, numbness, or shooting pain in the sole of the foot.
Recognising the Symptoms
Burning Sole Pain
Burning or aching pain on the sole of the foot, most often centred on the heel and arch. Often worse late in the day, after prolonged standing, or with certain shoes.
Tingling & Numbness
Pins and needles, "walking on pebbles" sensations, or patches of reduced sensation on the sole of the foot.
Night Symptoms
Flare-ups overnight, sometimes severe enough to wake you. Reduced movement at night seems to make positional symptoms worse.
Radiating Symptoms
Symptoms may shoot up into the calf or down into the toes — mimicking sciatica or a forefoot problem.
Foot Weakness
In long-standing cases, subtle weakness of the small foot muscles, with arch flattening or weak toe movement.
Worse with Activity
Walking, running, hiking, or prolonged standing make the symptoms worse. Rest typically improves them — but not always.
Why Accurate Diagnosis Matters
Foot pain is one of the most common reasons people see a GP, podiatrist, or physiotherapist. Many conditions cause similar symptoms, and the wrong diagnosis means the wrong treatment for years. A nerve conduction study is the single test that directly confirms or excludes tarsal tunnel syndrome and identifies generalised neuropathy or radiculopathy if either is present.
| Condition | Distinguishing feature |
|---|---|
| Plantar fasciitis | Sharp heel pain with the first steps after rest. No numbness. Pain settles with continued walking. |
| Peripheral neuropathy | Bilateral, symmetrical, often stocking distribution. Frequently linked to diabetes, B12 deficiency, or thyroid disease. |
| Small fibre neuropathy | Burning feet with normal large-fibre nerve conduction studies. Requires autonomic testing (SudoScan) or skin biopsy. |
| Lumbar S1 radiculopathy | Pain begins in the lower back and radiates down to the foot. Often back/leg pain, not purely sole burning. |
| Morton's neuroma | Pain between the toes from a forefoot interdigital nerve — not the tarsal tunnel. Often described as a "pebble in the shoe". |
| Tibialis posterior tendinopathy | Pain on the inside of the ankle, no numbness, often with arch collapse. |
What to Expect at Your Test
Brief clinical assessment
Dr Granot reviews your symptoms, history, and examines your foot — including Tinel's sign and sensory testing of the sole.
Surface electrode setup
Small adhesive pads (electrodes) are placed on the foot and lower leg. You'll need to remove your shoe and sock — otherwise, no special preparation is required.
Nerve conduction recordings
Brief, mild electrical pulses are applied over the posterior tibial nerve at the ankle and at the knee. Sensory responses from the medial and lateral plantar nerves and motor responses from the abductor hallucis muscle are recorded. Most people describe the pulses as a brief tap or tingle.
Needle EMG (if indicated)
In selected cases, a fine needle electrode is used to assess the small foot muscles for signs of denervation. This adds 10–15 minutes and confirms the severity and chronicity of any nerve damage.
Same-day results & report
Dr Granot reviews the findings with you immediately. You leave knowing what was found and what the next steps are. A formal written report is sent to your referring doctor the same day — no 4–6 week wait.
Treatment Options After Diagnosis
Treatment depends on the severity, the underlying cause, and how long the symptoms have been present. The path usually starts conservatively and escalates only if needed.
Conservative Care
Activity modification, custom orthotics to correct foot mechanics, anti-inflammatory medication, and targeted physiotherapy. Effective in most early cases.
Identifying a Cause
MRI or ultrasound of the ankle to look for a ganglion cyst, accessory muscle, post-traumatic scarring, or varicose veins — anything compressing the nerve that could be addressed directly.
Corticosteroid Injection
A targeted corticosteroid injection into the tarsal tunnel can reduce inflammation around the nerve and produce lasting relief in selected cases.
Surgical Release
Tarsal tunnel release — surgical decompression of the nerve — is considered when conservative measures fail and nerve conduction studies confirm significant compression. Performed by an orthopaedic or neurosurgeon.
Frequently Asked Questions
Serving Sydney's Eastern Suburbs
Our Bondi Junction clinic is conveniently located and easily accessible from Bondi, Bondi Beach, Bronte, Coogee, Double Bay, Rose Bay, Randwick, Woollahra, Paddington, and throughout Sydney's eastern suburbs. With excellent public transport links and nearby parking, we make nerve conduction testing convenient for all Sydney residents.
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