Tarsal tunnel syndrome refers to neuralgia of the tibial nerve or any of its terminal branches within the tarsal tunnel of the ankle. Often, this syndrome refers to a compression or entrapment neuropathy, but it may also be secondary to a neurapraxia. Tarsal tunnel syndrome may be caused by space-occupying lesions, trauma, deformity, and malalignment of the lower extremity. However, a specific cause for tarsal tunnel syndrome is found in only 60% to 80% of patients. Treatment of tarsal tunnel syndrome is patient-specific, depending on the underlying etiology. Nonsurgical management includes the use of anti-inflammatory medications and other medications used for neuralgia. Braces, including foot orthoses, stirrup braces, prefabricated ankle-foot orthoses, and boot braces, can be effective as a mechanical first-line treatment. When nonsurgical options fail to relieve symptoms, or when there is a specific surgical indication, surgical procedures, including nerve decompression and release, surgical excision of a compressive lesion, and deformity correction, may be useful. This article highlights the diagnosis and work-up of patients with tarsal tunnel syndrome, and describes the technique for decompression of the tarsal tunnel through release of the tibial nerve and its associated branches.