Tarsal tunnel syndrome is a compressive neuropathy of the posterior tibial nerve beneath the flexor retinaculum on the medial ankle. Several intrinsic or extrinsic factors may contribute to pain over the medial plantar aspect of the foot that is aggravated by activities. In the presence of suggestive clinical features, appropriate use of radiographic and electrodiagnostic tests can be helpful. Surgical management is considered in patients who do not respond to non-operative treatment or those who have a space-occupying lesion within the tarsal tunnel. Along with surgical decompression of the posterior tibial nerve, complete removal of the causative space-occupying lesion is needed to prevent recurrence.