Three patients who originally presented with a mass in the tarsal tunnel are described to develop an algorithm for management of the tarsal ganglion. All three patients had complications from ganglion excision, including complete division of the posterior tibial nerve, injury to the posterior tibial artery, and ganglion recurrence. The guiding principles relating to the presence of an extraneural versus an intraneural ganglion are developed. An example of a posterior tibial intraneural ganglion is presented. (J Am Podiatr Med Assoc 95(5): 459–463, 2005)