Medial Calcaneal Nerve Entrapment. A common but often missed cause of heel and inner ankle pain

What Is the Medial Calcaneal Nerve?

The medial calcaneal nerve is a small sensory nerve that branches from the tibial nerve. It passes behind the inner ankle, under a thick band of tissue (the flexor retinaculum), and supplies sensation to the inner heel and the sole of the foot.

Because of its location, this nerve is vulnerable to compression, especially around the inner ankle.

Why Does the Medial Calcaneal Nerve Get Trapped?

The most common cause of medial calcaneal nerve entrapment is external compression or local adhesion, usually from:

• Poorly fitting or overly tight footwear

• Shoes that press on the inner ankle

• Old ankle sprain or fracture

Another frequent cause is foot overpronation (the foot collapsing inward). This increases pressure in the inner ankle area and compresses the structures passing through it, including the nerve.

Less common causes include:

• Inflammatory conditions such as rheumatoid arthritis

• Degenerative joint disease in the ankle

• Cysts or ganglions forming along the nerve pathway

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Symptoms – How This Pain Usually Feels

Patients typically describe:

• Burning or sharp pain on the inner side of the ankle

• Pain in the heel, sometimes spreading into the sole of the foot

• Symptoms that worsen with standing, walking, or weight-bearing

The pain often:

• Starts mild and is easy to ignore

• Gradually increases over time

• Or remains at a low but persistent level for months

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Diagnosis

A common clinical test used during examination is the Tinel–Hoffmann test, where gentle tapping over the nerve reproduces the patient’s symptoms.

Because the symptoms can be very similar, it is important to rule out:

• Tarsal tunnel syndrome

• Plantar fasciitis

A thorough physiotherapy assessment is essential to identify the true source of heel pain.

Treatment – What Actually Helps

The most important step in treatment is removing the cause of nerve compression. This may include:

• Changing footwear

• Reducing pressure around the inner ankle

• Correcting foot and ankle alignment

• Improving the quality of the tissues by adhesion release

Postural and movement retraining should not focus only on the foot. Proper ankle alignment depends heavily on:

• Hip function

• Knee control

• Whole-body movement patterns

In some cases, the root cause may even be higher up the chain, such as:

• Poor balance control

• Vision problems

• Reduced hearing on one side affecting postur

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Insoles – When Are They Useful?

For people with very low physical demands who are not willing or able to retrain movement patterns, a supination insole (supporting the inner foot arch) may reduce symptoms.

However, this should be considered a symptom-management tool, not a long-term solution to the underlying problem.

Why This Condition Is Often Missed

Medial calcaneal nerve entrapment is frequently confused with:

• Plantar fasciitis

• Tarsal tunnel syndrome

As a result, many patients receive treatments that do not address the real cause of their pain.

References

1. Counsel P.D. et al. Ultrasound-guided radiofrequency denervation of the medial calcaneal nerve. Clinical Journal of Sport Medicine, 2016.

2. Rose J.D. et al. Neurosensory testing of the medial calcaneal nerve in plantar heel pain. Journal of Foot and Ankle Surgery, 2003.

3. Diers D.J. Medial calcaneal nerve entrapment as a cause of chronic heel pain. Physiotherapy Theory and Practice, 2009.