If the entrapment is high, the entire foot can be affected as varying branches of the tibial nerve can become involved.

The flexor retinaculum has a limited ability to stretch, so increased pressure will eventually cause compression on the nerve within the tunnel.

Some of the symptoms are: Tinel's sign is a tingling electric shock sensation that occurs when you tap over an affected nerve.

This would include benign tumors or cysts, bone spurs, inflammation of the tendon sheath, nerve ganglions, or swelling from a broken or sprained ankle.

These masses, in a specific case, were shown to have the ability to invade the tarsal tunnel causing pressure, therefore resulting in TTS.

[7] Anything compromising the tunnel of the posterior tibial nerve proves significant in the risk of causing TTS.

By association, this includes risk factors such as RA, compressed shoes, pregnancy, diabetes and thyroid diseases[8] Diagnosis is based upon physical examination findings.

Patients' pain history and a positive Tinel's sign are the first steps in evaluating the possibility of tarsal tunnel syndrome.

Common causes include trauma, varicose veins, neuropathy and space-occupying anomalies within the tarsal tunnel.

An evidence-based practice topic put forth by the professional organization, the American Association of Neuromuscular & Electrodiagnostic Medicine has determined that Level C, Class III evidence exists for the use of tibial motor nerve conduction studies, medial and lateral plantar mixed nerve conduction studies, and medial and lateral plantar sensory nerve conduction studies.

[10] Studies have found that patients with rheumatoid arthritis (RA) show signs of distal limb neuropathy.

The posterior tibial nerve serves victim to peripheral neuropathy and often show signs of TTS amongst RA patients.

One being immobilization, by placing the foot in a neutral position with a brace, pressure is relieved from the tibial nerve thus reducing patients pain.

Another common problem is improper footwear, having shoes deforming the foot due to being too tight can lead to increased pressure on the tibial nerve.

Treatments typically include rest, manipulation, strengthening of tibialis anterior, tibialis posterior, peroneus and short toe flexors, casting with a walker boot, corticosteroid and anesthetic injections, hot wax baths, wrapping, compression hose, and orthotics.

The initial treatment, whether it be conservative or surgical, depends on the severity of the tarsal tunnel and how much pain the patient is in.

[17] There is also the option of localized steroid or cortisone injection that may reduce the inflammation in the area, therefore relieving pain.

In the Pfeiffer article (Los Angeles, 1996),[full citation needed] fewer than 50% of the patients reported improvement, and there was a 13% complication rate.

Depending on the severity, the ability to walk distances people normally take for granted (such as grocery shopping) may become compromised.

The athletic population tends to put themselves at greater risk of TTS due to the participation in sports that involve the lower extremities.

Examples of sports that can lead to TTS include basketball, track, soccer, lacrosse, snowboarding, and volleyball.

According to South Korea's National Intelligence Service, North Korean leader Kim Jong Un had surgery to correct TTS in his right ankle, the source of a pronounced limp.

[20] Tests that confirm or correct TTS require expensive treatment options like X-rays, CT-scans, MRI and surgery.

The three former options for TTS detect and locate, while the latter is a form of treatment to decompress tibial nerve pressure.

[24] Since surgery is the most common form of TTS treatment, high financial burden is placed upon those diagnosed with the rare syndrome.