Tarsal Tunnel Syndrome

What is Tarsal Tunnel Syndrome?

Tarsal tunnel syndrome is a condition that is caused by compression of the Tibial Nerve or its associated branches as the nerve passes underneath the flexor retinaculum at the Medial Malleolus [Ankle]. This condition is similar to Carpal Tunnel Syndrome at the wrist.

Symptoms of Tarsal Tunnel Syndrome?

Pain (often described as burning) radiating into the arch of the foot, heel and sometimes the toes. Pins and needles or numbness may be felt in the sole of the foot. Pain when running. Pain when standing for long periods of time. Pain is relieved by rest. Pain is often worst at night. Tapping the nerve (just behind the medial malleolus) may reproduce pain. This is known as Tinels Test. The area under the medial malleolus may be tender to touch.

The symptoms of tarsal tunnel syndrome may initially be mistaken for plantar fasciitis which also causes pain from the medial heel and throughout the arch of the foot. Neural symptoms (such as tingling or numbness) as well as the location of tenderness when touching the area should help to easily distinguish between the conditions.

Tarsal Tunnel Syndrome Explained

Tarsal tunnel syndrome is an entrapment/compression neuropathy of the posterior tibial nerve. If you over pronate [your foot rolls in when you walk or run as shown] then pressure is put on these nerves which can become inflamed causing tarsal tunnel syndrome. Because the condition is often due to over pronation, it is common for bilateral tarsal tunnel syndrome to occur [i.e. in both feet!] The term anterior tarsal tunnel syndrome is sometimes applied to a rare entrapment of the deep peroneal nerve at the front of the ankle, although this is not strictly the same as tarsal tunnel syndrome. Symptoms appear on the top of the foot and radiate towards the 1st and 2nd toes.

What Causes It?

Tarsal tunnel syndrome can be both idiopathic meaning it occurs spontaneously or can be associated with a traumatic injury. Osteoarthritis at the ankle joint possibly as a result of an old injury Rheumatoid arthritis Diabetes Over pronation Tenosynovitis Talonavicular coalition fusing of two of the tarsal bones. A cyst or ganglion in the tarsal tunnel. In people involved in running or running based sports, where the condition occurs spontaneously, than over pronation is the most frequent cause.

Testing in Tarsal Tunnel Syndrome

There are common physical tests for carpal tunnel syndrome. In the Dorsiflexion Eversion Test the examiner flexes the ankle backward (dorsiflexion) and everts the ankle (turns the ankle outward). When the ankle is dorsiflexed the tibial nerve is placed on stretch in the area of the tarsal tunnel. At the same time the eversion movement tenses the flexor retinaculum. These two physical challenges stretching the nerve and compressing it often create or worsen the pain of tarsal tunnel syndrome. Other physical tests include tapping or strumming the nerve to determine if it is irritated. Medical evaluation may include ultrasound or nerve conduction testing. If the nerve is severely damaged and/or getting worse then surgery may be the best option. However, many people attempt to deal with the problem non-surgically and only proceed with surgery if the

symptoms are becoming progressively worse with conservative care. The information on this page is to help people with conservative care. Many different hands on practitioners may be helpful ranging from physiotherapists, chiropractors, osteopaths and massage therapists. Since I am a massage therapist, myself care suggestions are shaped by my training and my experiences with clients.

Massage Therapy for Tarsal Tunnel Syndrome

There are many ways that massage therapy can be used to treat Tarsal Tunnel Syndrome. The massage therapist will employ a number of techniques to relieve the condition. For example the massage therapist may use Neuromuscular Therapy or Trigger Point Therapy to eliminate myofascial trigger points and associated tension in the flexor muscles whose tendons pass through the tarsal tunnel. The massage therapist could also use Myofascial Release techniques or Deep Tissue Massage techniques to release adhesions between the flexor retinaculum forming the tarsal tunnel and the tissues passing through the tunnel while also using Muscle Energy Techniques to gently lengthen the same muscles to reduce tension in the tissues. Tarsal Tunnel Syndrome also responds well to positional release therapies such as OrthoBionomy which work with the bodys nervous system to release muscles and improve joint movement in the area especially in the subtalar joint and arch of the foot. Comprehensive treatment with massage and bodywork, in conjunction with a home program of stretching and exercise, may help to completely resolve Tarsal Tunnel Syndrome.

Other Treatments for Tarsal Tunnel Syndrome

While massage therapy and bodywork are an excellent treatment for Tarsal Tunnel Syndrome there are other treatments you should discuss with your physician:

Corticosteroid Injection Anti-inflammatory medications (NSAIDS) Functional Foot Orthotics Dorsal Night Splint Decompressive Surgery

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