Tinel’s Sign (Ankle)

Tinel’s Sign at the ankle is a clinical test used to detect peripheral nerve irritation or entrapment, most commonly at the tarsal tunnel (on the medial side of the ankle), which may indicate tarsal tunnel syndrome—compression of the posterior tibial nerve or its branches. Similar to its use in the wrist for carpal tunnel syndrome, it helps identify “pinched nerve” conditions around the ankle and foot.

How the Test is Performed

• Client position: Seated or lying with the foot and ankle relaxed and exposed.

• The examiner uses their fingers or a reflex hammer to gently tap or percuss over the tarsal tunnel—the area just posterior (behind) the medial malleolus (the inner ankle bone), along the path of the posterior tibial nerve.

• A positive test: The client experiences “electric shock” sensations, tingling, numbness, or shooting pain radiating into the foot or toes in the distribution of the posterior tibial nerve or its branches (plantar surface of the foot).

  • Symptoms may sometimes radiate upwards toward the calf (Valleix phenomenon).

Clinical Significance

• A positive Tinel’s Sign at the ankle indicates irritation or compression of the posterior tibial nerve—classic in tarsal tunnel syndrome, but may occur in any peripheral nerve entrapment at the ankle or foot.

• Not 100% sensitive or specific; it should be interpreted within the context of a full clinical exam and may be negative even with nerve compression, or positive in some non-compressed cases.

• Chronic nerve entrapment may cause numbness, weakness, atrophy in foot muscles, or altered gait/posture.

Assessment

• Use Tinel’s Sign for clients with burning, tingling, numbness, or shooting pain in the foot/ankle, especially along the medial or plantar region, or after trauma/swelling near the tarsal tunnel.

• Document:

  • Presence or absence of Tinel’s Sign

  • Distribution and intensity of symptoms

  • Any aggravation following trauma, overuse, or chronic swelling.

Treatment

• If positive:

  • Avoid deep, aggressive manual therapy, direct pressure, or friction over the affected nerve/course, as this may worsen irritability.

  • Prioritize gentle myofascial and lymphatic techniques, neural gliding/mobility exercises (when cleared), and reduction of local swelling (edema) with non-compressive strategies.

  • Educate about activity modification, footwear adjustment, and posture changes to reduce nerve compression (avoid tight shoes, long periods on hard surfaces).

  • Refer for medical/physiotherapy evaluation if nerve symptoms are persistent, worsening, or associated with motor weakness or atrophy.

Safety and Referral

• Refer promptly for specialist assessment if there is persistent numbness, muscle weakness, severe pain, or rapid progression of symptoms.

• Consider interdisciplinary care if nerve compression is occupational, post-traumatic, or associated with systemic disease (e.g., diabetes).