Tarsal Tunnel Syndrome
What is It?
Tarsal tunnel syndrome is a condition that affects the tibial nerve on the inner side of the ankle. The tibial nerve passes through the tarsal tunnel and provides sensation and muscular control to certain muscles in the foot.
When the tibial nerve is irritated in this area, it may lead to symptoms such as pain, numbness, tingling, or burning sensations along the inner ankle and/or sole of the foot.
Causes of Tarsal Tunnel Syndrome
1. Suboptimal Biomechanics
Biomechanics and gait patterns that involve the foot, knee, and/or hip may contribute to excessive pronation (flat-feet) and can result in irritation of the tibial nerve.
Direct injury to the foot and/or ankle, such as a sprain, strain, or fracture can cause swelling and inflammation within the tarsal tunnel.
Activities that involve repetitive movements or excessive use of the foot can irritate the tarsal tunnel.
Examples include prolonged walking or running, participating in high-impact sports, or occupations that require prolonged standing or walking.
4. Weight Change
Sudden changes in weight can increase the stress in the tarsal tunnel junction, which may affect the tibial nerve.
During pregnancy, hormonal changes, weight gain, and fluid retention can lead to swelling within the tarsal tunnel and affect the tibial nerve.
6. Underlying Conditions
Systemic conditions that affect nerves, such as peripheral neuropathy as a result of diabetes, can affect the tibial nerve.
Inflammatory conditions such as rheumatoid arthritis or tendinitis can cause swelling to occur near the tarsal tunnel leading to irritation of the tibial nerve.
How does physiotherapy Treat Tarsal Tunnel Syndrome?
Resolves the root cause
During the assessment, your therapist will determine why your tibial nerve is irritated or compressed. Your therapist will then provide treatments, prescribe exercises, and educate you on how to reverse your tarsal tunnel symptoms.
1. Manual Therapy
Myofascial release: to reduce pain, tightness, and inflammation of the muscles, joints, nerves, and fascia of the affected areas.
Joint mobilization: to promote smooth joint movement and mobility of the back, pelvis, hip, and other affected areas.
2. Biomechanical Optimization
Improves alignment and stability of the hips, knees, and feet.
Postural conditioning: corrects any contributing postural imbalances around the hip, knee, and foot that may contribute to tibial nerve compression.
Movement pattern conditioning: optimizing walking mechanics by recruiting the appropriate hip, knee, and foot muscles.
3. Exercise Therapy
Stretching: to reduce tightness of the muscles and passive structures that can compress and irritate the tibial nerve.
Strengthening: to improve the activation and stability of the muscles around the foot, ankle, knee, and hip.
Nerve gliding: to mobilize the tibial nerve and decrease the amount of compression exerted onto it.
Home exercise program: individualized exercise prescription to restore optimal and balanced movement.
Acupuncture: use of thin needles to improve local and systemic function, regulate the nervous system, and promote the body’s natural healing processes.
Heat and cold therapy: to manage reduce pain and tension or control inflammation.
Electrostimulation: use of electrical currents to stimulate muscles and reduce pain.
Ultrasound: use of high-frequency sound waves to produce deep tissue heating to reduce muscle tension, fascial tension, and inflammation.
Laser therapy: to improve blood flow, reduce pain and inflammation, and promote tissue healing.
Recommendations regarding lifestyle and activity modifications, posture, sleeping position, and shoe wear to help reduce load, risk of recurrence, and further injury.