The concept is similar – a nerve that is compressed as it passes through a canal – but neither the nerve, nor the anatomy, nor the treatment are the same. In carpal tunnel, the median nerve is trapped in the wrist; in tarsal tunnel, the posterior tibial nerve is trapped in the ankle. Tarsal tunnel is less frequently diagnosed and usually has a biomechanical component (valgus flatfoot) that is not present in the wrist. It should therefore be evaluated specifically.

At night, the venous return of the foot decreases and the small vessels of the tunnel ingurgitate, increasing the pressure on the nerve. In addition, by being immobile, you lose the natural “massage” that walking produces and the nerve is more exposed to the edema accumulated during the day. It is very common for patients to tell us that they get up and walk around the house to relieve themselves: this gesture momentarily reduces the intratunnel pressure.

In mild cases or those of pure biomechanical origin – pronator foot, work overload, fluctuating edema – conservative treatment with insoles, modification of footwear, physiotherapy and, if necessary, ultrasound-guided infiltration can control symptoms in a significant proportion of patients. When there is an occupying structural cause (ganglion, varicose veins, chronic synovitis) or the nerve already shows neurophysiological alteration, surgery is usually the most effective option in the medium term.

Yes, diabetes makes the nerve more vulnerable to compression and, if blood glucose is poorly controlled, symptoms tend to be more intense and recovery slower. In diabetic patients, diffuse polyneuropathy and focal tunnel entrapment often coexist: this is why neurophysiological studies are so important to differentiate between the two components and to plan the treatment well, especially if surgery is considered.

MIS decompression of the flexor retinaculum takes 30 to 45 minutes in most cases. The previous preparation, local anesthesia and the immediate postoperative period add approximately one hour more in the clinic. It is an outpatient procedure: you walk in on your foot and walk out too, with post-surgical off-loading shoes, without the need for hospitalization or general anesthesia.

Yes, the philosophy of MIS surgery is precisely that: local anesthesia, no plaster and immediate loading with post-surgical footwear. Unless medically contraindicated, you leave the clinic walking. During the first 7-10 days we recommend limiting long walks, keeping the foot elevated at rest and applying the care guidelines we give you in writing. The mobility of the ankle recovers progressively.

Pain and burning relief is usually noticeable within the first few weeks. The recovery of fine sensation depends on how long the nerve has been compressed: if it is recent, it recovers fairly quickly (weeks to months); if you have had symptoms for years, the nerve may take 6 to 12 months to regenerate and, in some cases, a small area of altered sensation remains. We will follow up with you periodically to evaluate it.

Recurrence is possible, especially if the underlying cause has not been treated: for example, a valgus flatfoot that continues to tract the nerve or a varicose vein that grows back. Therefore, in addition to freeing the tunnel, we plan the postoperative period with corrective insoles and, if necessary, address the structural cause. Review series place recurrence in a minority of patients when the surgical indication is precise.

If your foot pronates or you have hindfoot valgus, a custom insole that corrects the mechanics reduces sustained traction on the posterior tibial nerve. It does not guarantee that you will not develop the condition, but it clearly lowers the risk and, in patients with initial symptoms, it can slow progression. The generic insole is no good: it needs a biomechanical study and individualized design for your foot.