In 14 patients tarsal tunnel syndrome was associated with varus heels and pronated, splayed forefeet. Review of the literature and the author's experience suggest that these conditions may be a common cause of the tarsal tunnel syndrome. Treatment of fixed varus deformities of the heel by outer heel wedges has been shown to be ineffective. Although outer heel wedges provide symptomatic relief in patients with relatively flexible hindfeet, surgical release of the flexor retinaculum behind the medial malleolus is the treatment of choice in patients who have the tarsal tunnel syndrome with planovarus deformity and is successful in more than 90% of cases. The tarsal tunnel syndrome, in the author's experience, is grossly underdiagnosed. Tarsal tunnel syndrome should be suspected in patients who have pain in the bottom of the feet without localized forefoot tenderness, who have a varus heel and a pronated, splayed forefoot, and who have a positive Tinel's sign behind the medial malleolus. It is important to differentiate tarsal tunnel syndrome from a peripheral neuropathy that obviously will not respond to surgical intervention.