Medial Plantar Nerve Entrapment, Jogger's Foot

with Rehab

ExitCare ImageMedial plantar nerve entrapment affects the nervous system and causes pain and sometimes a loss of feeling in the foot, especially in the first (big) and second toes. An increase in pressure is placed on the medial plantar nerve by ligament-like tissue (fascia), which causes the symptoms.

SYMPTOMS

  • Tingling, numbness, or burning from the arch of the foot to the first (big) and often second toe.

  • Pain and tenderness along the arch of the foot.

  • Pain that gets worse when standing on the tiptoes of the affected foot or after running.

  • A feeling of the ankle giving way.

  • Symptoms that get worse, or that are only present, during and after running on level ground.

CAUSES

Increased pressure placed on the medial plantar nerve by structures that surround it causes medial plantar nerve entrapment. Pinching of the nerve by connective tissue (fascia) and muscle or bone most commonly causes the increase in pressure. However, increased pressure may also be caused by inflammation of the connective tissues on the sole of the foot (plantar fascia).

RISK INCREASES WITH:

  • Recurring ankle sprains.

  • Sports that involve a lot of running (distance running).

  • External pressure being placed on the nerve (tight-fitting shoes, shoes with minimal padding, shoes with loss of shock absorbers, or use of new arch supports).

  • Looseness of the joints of the foot, flat feet, or stiffness of the big toe (hallux rigidus).

  • New arch supports that have high arches.

  • Medical disorders, including diabetes mellitus and thyroid disorders.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Wear properly fitted and padded equipment (shoes and orthotics).

  • Taping, protective strapping, bracing, or high-top tennis shoes may help prevent ankle sprains and nerve stretching injury.

PROGNOSIS

If treated properly, medial plantar nerve entrapment usually goes away with non-surgical treatment. Medial plantar nerve entrapment may also go away on its own (spontaneously). Sometimes, surgery is needed.

RELATED COMPLICATIONS

  • Permanent numbness in the foot and toes.

  • Persistent pain in the foot or ankle.

  • Inability to compete in sports, due to pain.

TREATMENT

Treatment first involves resting from any activity that makes your symptoms worse. The use of ice and medicine will help reduce pain and inflammation. Orthotics (arch supports and heel raises) are helpful for reducing symptoms. It is important to incorporate cross-training activities into your training schedule. The use of strengthening and stretching exercises may help reduce pain with activity, especially exercises focused on the Achilles tendon. These exercises may be performed at home or with a therapist. If symptoms do not go away after at least one year of non-surgical treatment, surgery may be needed to free the entrapped nerve. Recovery after surgery usually lasts around 6 weeks.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 2 weeks, despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Medial Plantar Nerve Entrapment (Jogger's Foot)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION - Toe Extension, Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Grasp your toes and gently pull them back toward the top of your foot. You should feel a stretch on the bottom of your toes and foot.

  • Hold this stretch for __________ seconds.

  • Now, gently pull your toes toward the bottom of your foot. You should feel a stretch on the top of your toes and foot.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Eversion

  • Sit with your right / left ankle crossed over your opposite knee.

  • Grip your foot with your opposite hand, placing your thumb on the top of your foot and your fingers across the bottom of your foot.

  • Gently push your foot downward with a slight rotation so your littlest toes rise slightly toward the ceiling.

  • You should feel a gentle stretch on the inside of your ankle. Hold the stretch for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH – Gastroc, Standing

  • Place your hands on a wall.

  • Extend your right / left leg behind you, keeping the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keeping your right / left heel on the floor and your knee straight, shift your weight toward the wall, not allowing your back to arch.

  • You should feel a gentle stretch in the __________ calf. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Soleus, Standing

  • Place your hands on a wall.

  • Extend your right / left leg behind you, keeping the other knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keep your right / left heel on the floor, bend your back knee, and slightly shift your weight over the back leg so that you feel a gentle stretch deep in your back calf.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Gastrocsoleus, Standing

Note: This exercise can place a lot of stress on your foot and ankle. Please complete this exercise only if specifically instructed by your caregiver.

  • Place the ball of your right / left foot on a step, keeping your other foot firmly on the same step.

  • Hold on to the wall or a rail for balance.

  • Slowly lift your other foot, allowing your body weight to press your heel down over the edge of the step.

  • You should feel a stretch in your right / left calf.

  • Hold this position for __________ seconds.

  • Repeat this exercise with a slight bend in your right / left knee.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH – Hamstrings, Supine

  • ie on your back. Loop a belt or towel over the ball of your right / left foot.

  • Straighten your right / left knee and slowly pull on the belt to raise your leg. Do not allow the right / left knee to bend. Keep your opposite leg flat on the floor.

  • Raise the leg until you feel a gentle stretch behind your right / left knee or thigh. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image STRETCH - Hamstrings, Standing

  • Stand or sit and extend your right / left leg, placing your foot on a chair or foot stool.

  • Keep a slight arch in your low back and your hips straight forward.

  • Lead with your chest and lean forward at the waist until you feel a gentle stretch in the back of your right / left knee or thigh. (When done correctly, this exercise requires leaning only a small distance.)

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Medial Plantar Nerve Entrapment (Jogger's Foot)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

ExitCare Image STRENGTH - Towel Curls

  • Sit in a chair, on a non-carpeted surface.

  • Place your foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel only by curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist or athletic trainer, weight may be added at the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ankle Eversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (table, pole). Loop the other end around your foot, just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Drawing the band across your opposite foot, away from the pole, slowly, pull your little toe out and up. Make sure the band is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band, as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ankle Inversion

  • Secure one end of a rubber exercise band or tubing to a fixed object (table, pole). Loop the other end around your foot, just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Slowly, pull your big toe up and in, making sure the band is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band, as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercises __________ times per day.