The tarsal tunnel is located on the inside aspect of your ankle on both feet (see the image below). The “tunnel” is a passageway for tendons, nerves, and blood vessels to pass from your calf to the bottom of your foot. With normal foot alignment, the tunnel has enough space to allow all the components in the tunnel to move freely without being compressed or putting on too much tension. However, pronated feet (also called “flat feet”) put excessive stress on the tarsal tunnel. Now why is this a problem?
What’s the Big Deal?
As it pertains to this discussion, the main player in tarsal tunnel syndrome is the tibial nerve, which is the nerve for the muscles and sensory receptors in the bottom of the foot. Likewise, common complaints that correspond with tarsal tunnel syndrome include both sensory and muscular changes, such as: numbness and tingling in the heel and/or bottom of the foot and weakness of toe muscles. Similarly, activities that involve moving the affected foot, such as walking, swimming, and standing, can cause pain. With all of these problems, what can we do to fix it?
So How Can You Fix This?
Currently, the literature is limited in the area of tarsal tunnel syndrome; however, there is some research to support both surgical and conservative treatments. Surgery involves relieving pressure in the area by cutting the “roof” of the tunnel (or the flexor retinaculum). Additionally, some surgeons elect to free up the tibial nerve and its branches from anything that may be adhered to the nerves. On the other hand, physical therapy offers a more conservative approach and can help to correct the issue of “flat feet” by supporting the arch of the foot, decreasing any inflammation with the use of modalities (which can include electrical muscle stimulation, traction, heat, ice, etc.), and breaking up any adhesions to the nerve using exercises aimed at targeting the tibial nerve and its branches.
For more information on tarsal tunnel syndrome or any other musculoskeletal complaints, contact Sports PT of NY at info@sptny.com.
References:
- T. Mullick and A. Dellon. “Results of Decompression of Four Medial Ankle Tunnels in the Treatment of Tarsal Tunnel Syndrome.” Journal of Reconstructive Microsurgery 24, no. 2 (February 2008): 119–126.
- P. Ward and M. Porter. “Tarsal Tunnel Syndrome: A Study of the Clinical and Neurophysiological Results of Decompression.” Journal of the Royal College of Surgeons of Edinburgh 43, no. 1 (February 1998): 35–36.
- M. Yalcinkaya, U. Ozer, M. Yalcin, and A. Bagatur. “Neurolysis for Failed Tarsal Tunnel Surgery.” The Journal of Foot and Ankle Surgery 53, no. 6 (November 2014): 794–798.
- J. Tennant, C. Rungprai, and P. Phisitkul. “Bilateral Anterior Tarsal Tunnel Syndrome Variant Secondary to Extensor Hallucis Brevis Muscle Hypertrophy in a Ballet Dancer: A Case Report.” Foot and Ankle Surgery 20, no. 4 (December 2014): e56–e58.
- A. Kosiyatrakul, S. Luenam, and P. Phisitkul. “Tarsal Tunnel Syndrome Associated with a Perforating Branch from Posterior Tibial Artery: A Case Report.” Foot and Ankle Surgery 21, no. 1 (March 2015): e21–e22.
- Y. Kavlak and F. Uygur. “Effects of Nerve Mobilization Exercise as an Adjunct to the Conservative Treatment for Patients with Tarsal Tunnel Syndrome.” Journal of Manipulative and Physiological Therapeutics 34, no. 7 (September 2011): 441–448.
- D. Diers. “Medial Calcaneal Nerve Entrapment as a Cause for Chronic Heel Pain.” Physiotherapy Theory and Practice 24, no. 4 (July 2008): 291–298.
- A. Alshami, A. Babri, T. Souvlis, and M. Coppieters. “Biomechanical Evaluation of Two Clinical Tests for Plantar Heel Pain: The Dorsiflexion-Eversion Test for Tarsal Tunnel Syndrome and the Windlass Test for Plantar Fasciitis.” Foot & Ankle International 28, no. 4 (April 2007): 499–505.