A 54-year-old male patient suffered from numbness at the medial aspect of the right ankle for months. Tinel's sign was positive. Magnetic resonance imaging (MRI) showed serpentine and worm-like tubular structures within the tarsal tunnel with intermediate signal intensity on T1-weighted images, high signal intensity on T2-weighted images, and strong gadolinium-contrast enhancement, which allowed specific diagnosis of varicose veins. After failed nonoperative management for months, surgical decompression was performed and varicose veins compressing the posterior tibial nerve was found. The patient was symptom free during postoperative out-patient department follow-ups without recurrence for years.