Summer weather brings more walking, running, flip-flop wearing, and foot pain! Recently a number of patients have presented to our downtown Toronto clinic complaining of plantar fasciitis. But interestingly enough, a few of these patients didn’t actually have plantar fasciitis but rather were diagnosed with tarsal tunnel syndrome. It is important to recognize that pain at the bottom of the foot does not always mean the plantar fascia is to blame. You may be suffering from Tarsal Tunnel Syndrome! So don’t rule it out until a qualified professional such as a physio, chiro or sports medicine physician conducts a detailed assessment and tells you otherwise.
What is Tarsal Tunnel Syndrome?
The tibial nerve begins behind the knee and runs down into the foot behind the medial malleolus, or bump on the inside of the ankle. As it passes behind this bony bump, it is tethered down by a band of tissue called the “flexor retinaculum” along with some other tendons and blood vessels. The passageway under the flexor retinaculum is called the “tarsal tunnel” and usually the tibial nerve branches into the medial and lateral plantar nerves, within the tunnel which innervates and give sensation to the bottom of the foot.
Tarsal tunnel syndrome results from an irritation of the tibial nerve within that tunnel. Any irritation caused by compression or friction of a nerve can result in inflammation and in more chronic situations nerves can actually become shorter and tighter and can even become scarred down in places. This means that instead of sliding easily through the tunnel and the tissues during every day foot movements, the tibial nerve gets pulled on and rubbed against which causes more inflammation and may lead to more scarring1.
What are the Symptoms of Tarsal Tunnel Syndrome?
Symptoms of tarsal tunnel syndrome vary widely depending on both the patient and the severity of nerve compression and/or irritation. Typically, paresthesia in the territory of the distal branches of the tibial nerve occurs, causing tingling, shooting pain, burning, or aching along the tibial nerve and into the plantar nerves1. If only one of the plantar or calcaneal nerves are affected, the dysfunction can be called distal tarsal tunnel syndrome.
Prolonged walking or standing can exacerbate the symptoms, and sometimes pressure over the nerve and tarsal tunnel can be painful. Tarsal tunnel syndrome can be both idiopathic or post-traumatic1.
How can Physiotherapy or Chiropractic Treatment Help Tarsal Tunnel Syndrome?
Physical therapy and chiropractic treatment for tarsal tunnel syndrome will depends on why the nerve is being compressed. Your health care professional will complete a thorough assessment to determine the root cause of your particular symptoms. A proper assessment would dictate what faulty foot position or weakness is causing the nerve irritation, and through manual therapy and exercise the therapist would work on correcting the underlying cause of the problem. Treatment may also focus on reducing swelling, inflammation and pain using therapeutic modalities, education and release. Your physiotherapist may also suggest foot inserts or in more extreme cases orthotics to help support your foot and resolve the symptoms more quickly.
What are the Best Exercises to do for Tarsal Tunnel Syndrome?
These are just a couple general exercises that may help with Tarsal Tunnel Syndrome. If you experience more pain or do not notice any improvement within a few days, we recommend seeking care from a trusted physio or chiro who will provide you with an individualized exercise program.
Tibial nerve flossing
Lying on your back with your knees bent, lift and hold the affected thigh. Slowly straighten and bend your knee in and out within a range of motion that is painfree. Add ankle dorsiflexion to the movement to target the tibial nerve. You may use a towel or a belt around your foot to intensify the tibial nerve stretch.
Repeat 15x 2x a day slow and controlled.
Tibialis posterior strengthening
Stand on the ground or with your feet over the edge of a step. Squeeze a tennis ball or something similar in size and density in between your heels. Perform calf raises by lifting your heels so until you are up balancing on the balls of your feet. Then slowly lower.
Repeat 15-20reps 3x a day.
How to Treat Tarsal Tunnel Syndrome at Home?
You first want to control inflammation with ice applied over the area just under your inner ankle bone- Apply the ice for 10min then switch to heat if that feels good and repeat the entire process 3x in a row. You can choose not to add the heat, but then before reapplying ice, wait until the skin returns back to room temperature.
Wear supportive shoes
Wear running shoes, insoles that support your arch or orthotics if you have them.
Perform Rehab Exercises
Please refer to exercises section above.
What to Avoid if you have Tarsal Tunnel Syndrome?
If you are suffering from Tarsal Tunnel Syndrome, you should avoid the following:
- Walking or standing for prolonged periods in bare feet especially on hard flooring.
- Ignoring the pain and not seeking treatment when it is not going away.
- Wearing tight fitting shoes or tying your laces to tightly.
- Wearing unsupportive flip flops, flats, dress shoes or high heels.
If you have pain on the bottom of your foot, contact us today to book in with one of our experienced physiotherapists who will help you determine the root cause of the pain and help you treat it so that it goes away for good!
- Antoniadis G, Scheglmann K. Posterior Tarsal Tunnel Syndrome. Diagnosis and Treatment. Dtsch Arztebl Int. 2008 Nov; 105(45): 776–781. doi: 10.3238/arztebl.2008.0776