Tarsal tunnel syndrome is relatively rare and the diagnosis may be difficult even though the etiologies for the syndrome are multiple. The symptoms are often vague but are usually burning pain and paresthesias in the toes and soles of the feet with nocturnal exacerbations. The physical examination may elicit a sensory deficit over the cutaneous distribution of the median and/or lateral plantar nerve. There may also be tenderness over the flexor retinaculum. Electrodiagnosis, especially with the addition of the orthodromic compound nerve action potential latency technique, is essential to confirm the diagnosis. The findings may be confined to the distribution of either the medial or lateral plantar nerves and, thus, both distal latencies must be determined. Surgical decompression of the tarsal tunnel has usually proven to be helpful in those patients who do not respond to conservative treatment.