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Tarsal
Tunnel Syndrome
Disclaimer:
While the information on this web site has been helpful to many
people, you should check with your medical doctor or other health
care professional in deciding what is the best course of action to
take for your situation. This information is designed to help you
be a better partner in your care, and not as a do-it-yourself guide
to diagnosing and/or treating your health care
issue.
What is
Tarsal Tunnel Syndrome?
Tarsal
tunnel syndrome is a condition in which the tibial nerve is
compressed in the bony/ligamentous tunnel that it runs through on
the inside of the ankle. The tibial nerve sends sensory information
from the heel and sole of the foot to up to the spinal cord and
brain. When the tibial nerve is compressed and/or inflamed in the
tarsal tunnel then the person may feel aching, pressure, tingling
and/or numbness in the heel and/or sole of the
foot.
What
Causes Tarsal Tunnel Syndrome?
The tibial
nerve can become compressed in the tarsal tunnel by thickening of
the tendons of the muscles that share the tunnel space with the
nerve. This thickening can be caused by tendonitis and/or by
overuse of the muscles (often by excessive pronation of the foot
during running.
The tarsal
tunnel can become a tight corridor due to excess fluid in the
person's body generally, or a local injury, ganglion, arthritis or
many other factors. Some people develop it due to poor
footwear!
You
should see your doctor if you think you have tarsal tunnel syndrome
for a medical diagnosis and possible treatment.
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, my self care suggestions are shaped
by my training and my experiences with clients.
Hands On
Treatment for Tarsal Tunnel Syndrome
The
following techniques may be helpful in reducing symptoms of tarsal
tunnel syndrome. They may be in the order below, or in a different
order with different emphasis depending on the clinical
situation.
1. Milking
fluid from the tarsal tunnel
2.
Releasing the flexor retinaculum
3. Milking
fluid from the ankle joint
4. Milking
fluid from within the tibial nerve
5.
Releasing the abductor hallucis muscle
6. Neural
sliding and gliding of the tibial nerve relative to the flexor
retinaculum
7.
Stretching the tibial nerve at the tarsal tunnel to release
adhesions within the nerve.
The You
Tube video below demonstrates some of the key interventions in
lessening tarsal tunnel syndrome.
In this You Tube video
clip the Abductor Hallucis muscle, which overlies the tibial nerve,
is released and lengthened to decompress the tibial
nerve.
Tarsal Tunnel Home
Care
Clients
with tarsal tunnel syndrome may need to address the following
issues.
1. Chronic
inflammation/swelling in the feet with better supporting footwear
and cool or cold foot baths
2. Chronic
foot pronation with orthotics
3. Weak
arches with the short foot exercise. Click here for
instructions.
Sometimes
tarsal tunnel syndromes come from nerve compression or irritation
further up the leg, as far as the hip or low back. Your health care
professional can help determine if this is the
case.
Questions,
comments, suggestions?
Contact
Doug Alexander by clicking here.
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