tarsal tunnel syndrome - sports podiatry

Tarsal tunnel syndrome is a condition that occurs from abnormal pressure on a nerve in the foot. The condition is similar to carpal tunnel syndrome in the wrist. The condition is somewhat uncommon and can be difficult to diagnose.

tarsal tunnel syndrome anatomy

The tibial nerve runs into the foot behind the medial malleolus, the bump on the inside of the ankle. As it enters the foot, the nerve runs under a band of fibrous tissue called the flexor retinaculum. The flexor retinaculum is a dense band of fibrous tissue that forms a sort of tunnel, or tube. Several tendons, as well as the nerve, artery, and veins that travel to the bottom of the foot pass through this tunnel. This tunnel is called the tarsal tunnel. The tarsal tunnel is made up of the bone of the ankle on one side and the thick band of the flexor retinaculum on the other side.

tarsal tunnel syndrome causes

In many cases, clinicians aren't sure what causes tarsal tunnel syndrome. Inflammation in the tissues around the tibial nerve may contribute to the problem by causing swelling in the tissues and pressure on the nerve.

Anything that takes up space in the tarsal tunnel can increase pressure in the area because the flexor retinaculum cannot stretch very much. This can occur from swollen varicose veins, a tumour (noncancerous) on the tibial nerve, and swelling caused by other conditions, such as diabetes. As pressure increases in the tarsal tunnel, the nerve is the most sensitive to the pressure and is squeezed against the flexor retinaculum. This causes problems in the nerve that may lead to symptoms of tarsal tunnel syndrome.

Tarsal tunnel syndrome symptoms

In the case of a nerve, the area of skin supplied by the nerve usually feels numb, and the muscles controlled by the nerve may become weak. Pain is sometimes felt near the area where the nerve is squeezed or pinched.

Tarsal tunnel syndrome usually causes a vague pain in the sole of the foot. Most patients describe this pain as a burning or tingling sensation. The symptoms are typically made worse by activity, especially standing and walking for long periods. Symptoms are generally reduced by rest. You may feel pain if you touch your foot along the course of the nerve. If the condition becomes worse, your foot may feel numb and weak.

tarsal tunnel syndrome treatment in the acute phase

P - R - I - C - E

Tarsal tunnel syndrome Restoring normal function

As we get older the risk of any type of tendon rupture goes up dramatically especially if we embark on high impact sporting activities. However it must be emphasised that the risk is still small but when recovering after any injury it is vital that when stretching or performing any exercise that there should be no pain. If any tenderness is elicited along the tarsal tunnel then stop and re commence P.R.I.C.E

Tarsal tunnel syndrome - eccentric exercises

The eccentric peroneal tendonitis stretching exercises below require the use of a theraband.

Begin eccentric exercise program 7-10 days after pain has subsided Start with toes pointed, giving resistance through the theraband, slowly allow your foot into dorsiflexion (upward position). Warning: There should be no tarsal tunnel pain when doing this exercise. If there is stop!

 

Below is a video showing the uses for the rehab band (whole body).

Tarsal tunnel syndrome- stretching exercises

Begin stretching regimen for gastrocnemius and soleus complex. Warning: There should be no pain in the tarsal tunnel when doing this exercise. If there is stop!

Perform a toe raise on a 4-6 inch box or step with both legs. Once on your toes, lift the uninvolved leg and lower yourself slowly into dorsiflexion (heel down, toe up).   Warning: There should be no tarsal tunnel pain when doing this exercise. If there is stop!

Tarsal tunnel syndrome - leg strengthening exercises

Perform a toe raise on a 4-6 inch box or step with both legs. Once on your toes, lift the one leg and lower yourself slowly into dorsiflexion (heel down) with the other. Repeat on the other side Warning: There should be no tarsal tunnel pain when doing this exercise. If there is stop!

 

Tarsal tunnel syndrome - Ankle strengthening exercises

 

Wobbleboard

 

Use of a wobbleboard is a brilliant way to strengthen muscles in the foot ankle and leg. Aim to do 5-10 minutes a day!

 

 

Tarsal tunnel syndrome - Theraband exercises

 

Frequency:

Three sets of 20 repetitions, 5-7 days per week

Front of Shin Basic - Push Out With your foot flat on the floor, push it outward against a wall, file cabinet or bookcase. Hold for three seconds.

Front of Shin Advanced - Band Tie the band to a desk or dresser. Sit with your foot and knee in line and loop the band over the outside of your foot. Push your foot out against the band.

Inner Shin Basic - Push In With your foot flat on the floor, push it inward against your other foot. Hold for three seconds.

Inner Shin Advanced - Band Tie the band to a desk or dresser. Sit with your foot and knee in line, and loop the band over the inside of your foot. Push your foot in against the band.

Front of Shin Basic - Push Up Place the heel of your other foot on top of the injured one. Push down with the top heel while trying to push up with the injured foot. Hold for three seconds.

Front of Shin Advanced - Band Tie the band to a desk or dresser. Sit with your leg straight and loop the band over the top of your foot. Slowly pull your foot back against the band.

to help prevent Tarsal tunnel syndrome

Remember that virtually all tarsal tunnel problems happen at the contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point. It is therefore vital to strengthen the ankle and control biomechanical forces.

Golden rule- Don't ignore the problem, it won't go away!

The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family). The way you function is set and cannot be cured. What you can do however is control lower limb biomechanics by altering foot position during the contact phase of gait. This can be achieved by wearing a good shoe (see our shoe guide) with orthotics (foot beds), ankle strengthening and ankle support.

1. Check your footwear

Are your running shoes worn and in need of replacing? If so change them. Tarsal tunnel syndrome is made worse by high impact forces so a good shock absorbing shoe is a must. For more advice on running trainers our running shoe advice page is worth reading. Read more->

Below are a selection of trainers that are ideal for athletes.

Trainers for a neutral or under pronating foot type

Trainers for over pronators

2. rectify Poor biomechanics with orthotics

The way your foot strikes the ground and the forces that are placed on it can have a direct effect on causing tarsal tunnel syndrome and can also delaying healing times. Check our biomechanics page for detailed information. Read more->

3. Ankle strengthening

The single best exercise to improve the strength of the muscles around the ankle is eccentric loading. This is usually done none weight bearing, however the use of a wobbleboard is an excellent way to strengthen muscles around the foot and ankle in a controlled gentle manner. Whilst our clinicians have found it a brilliant way to strengthen ankle muscles, traditionally a wobbleboard was used to help balance (proprioception). Proprioception is the nerve connection from the brain to the foot. This is often damaged/ disrupted after injury and can increase the chances of injury from re occurring. It can also significantly delay recovery.

Use of a wobbleboard therefore has a dual benefit in the treatment of tarsal tunnel syndrome.

 

4. Improve shock absorbency

 

Tarsal tunnel syndrome can be made worse by high impact forces being directed through the heel, particularly in running activities. Purchasing some shock absorbing insoles or heel pads is a cheap and effective way of vastly improving shock adsorbents and reducing unwanted ground reaction force. These little pads slip into the shoe and are not noticed by the athlete when partaking in sport.

 

Tarsal tunnel injury prevention checklist summary

returning to sporting activity after Tarsal tunnel has subsided

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen tarsal tunnel injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Returning to your activity is determined by how soon your injury recovers, not by how many days or weeks it has been since your injury occurred.

You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

You have full range of motion in the injured leg compared to the uninjured leg.

You have full strength of the injured leg compared to the uninjured leg.

You can jog straight ahead without pain or limping.

You can sprint straight ahead without pain or limping.

You can do 45-degree cuts, first at half-speed, then at full-speed.

You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.

You can do 90-degree cuts, first at half-speed, then at full-speed.

You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.

You can jump on both legs without pain and you can jump on the injured leg without pain.