Tarsal Tunnel Syndrome

with Rehab

Tarsal tunnel syndrome is a condition that involves pressure (compression) on the nerve in the ankle (posterior tibial nerve) and results in pain and loss of feeling on the bottom of the foot. The nerve is usually compressed by other structures within the ankle.

SYMPTOMS

  • Signs of nerve damage: pain, numbness, tingling, and loss of feeling along the bottom of the foot.

  • Pain that worsens with activity.

  • Feeling a lack of stability in the ankle.

CAUSES

Tarsal tunnel syndrome is caused by structures within the ankle placing pressure on the nerve inside the ankle, which causes sensations in the bottom of the foot. Common sources of pressure include:

  • Ligament-like tissue (retinaculum) that covers the nerve area in the ankle (tarsal tunnel).

  • Bony spurs or bumps.

  • Inflamed tendons (tendonitis).

RISK INCREASES WITH:

  • Stretched ankle ligaments, which create a loose joint.

  • Flat feet.

  • Arthritis of the ankle.

  • Inflammation of tendons in the foot and ankle.

  • Previous foot or ankle injury.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness (increases heart rate).

  • Wear properly fitted shoes.

  • Wear arch supports (orthotics), if you have flat feet.

  • Protect the ankle with taping, braces, or compression bandages.

PROGNOSIS

If treated properly, the symptoms of tarsal tunnel syndrome usually go away with non-surgical treatment. Occasionally, surgery is necessary to free the compressed nerve.

RELATED COMPLICATIONS

Permanent nerve damage, including pain, numbness, tingling, or weakness in the ankle.

TREATMENT

Treatment first involves resting from any activities that aggravate the symptoms, as well as the use of ice and medicine to reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain from activity. Other treatments include wearing arch supports, if you have flat feet, and cross training (training in various physical activities) to reduce stress on the foot and ankle. If symptoms persist, despite non-surgical treatment, then surgery may be recommended. Surgery usually provides full relief from symptoms.

MEDICATION

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

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

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

HEAT AND COLD

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

  • Heat treatment may be used prior to 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:

  • Treatment does not seem to help, or the condition worsens.

  • Any medicines produce negative side effects.

  • Any complications from surgery occur:

  • Pain, numbness, or coldness in the affected foot.

  • Discoloration beneath the toenails (blue or gray) of the affected foot.

  • Signs of infections (fever, pain, inflammation, redness, or persistent bleeding).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Tarsal Tunnel Syndrome (Posterior Tibial Nerve Compression)

These exercises may help you when beginning to restore activity to your injured foot. Complete these exercises with caution. Nerves are very sensitive tissue. They must be exercised gently. Never force a motion and do not push through discomfort. Notify your caregiver of any exercises which increase your pain or worsen your symptoms. Your symptoms may go away 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.

STRETCH – Gastroc, Standing

  • Place hands on wall.

  • Extend right / left leg behind you and place a folded washcloth under the arch of your foot for support. Keep 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 right / left calf. Hold this position for __________ seconds.

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

STRETCH – Soleus, Standing

  • Place hands on wall.

  • Extend right / left leg behind you and place a folded washcloth under the arch of your foot for support. Keep the front 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.

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.

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.

RANGE OF MOTION - Ankle Dorsiflexion, Active Assisted

  • Remove shoes and sit on a chair, preferably not on a carpeted surface.

  • Place right / left foot on the floor, directly under knee. Extend your opposite leg for support.

  • Keeping your heel down, slide your right / left foot back toward the chair until you feel a stretch at your ankle or calf. If you do not feel a stretch, slide your bottom forward to the edge of the chair while still keeping your heel down.

  • Hold this stretch for __________ seconds.

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

STRETCH – Hamstrings, Supine

  • Lie 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.

STRETCH - Hamstrings, Doorway

  • Lie on your back with your right / left leg extended and resting on the wall and the opposite leg flat on the ground through the door. Initially, position your bottom farther away from the wall than the illustration shows.

  • Keep your right / left knee straight. If you feel a stretch behind your knee or thigh, hold this position for __________ seconds.

  • If you do not feel a stretch, scoot your bottom closer to the door and hold __________ seconds.

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

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 keep 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 - Tarsal Tunnel Syndrome (Posterior Tibial Nerve Compression)

These exercises may help you when beginning to restore activity to your injured foot. Your symptoms may go away 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. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your caregiver.

STRENGTH - Dorsiflexors

  • Secure a rubber exercise band or tubing to a fixed object (table, pole) and loop the other end around your right / left foot.

  • Sit on the floor facing the fixed object. The band should be slightly tense when your foot is relaxed.

  • Slowly draw your foot back toward you, using your ankle and toes.

  • Hold this position for __________ seconds. Slowly release the tension in the band and return your foot to the starting position.

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

STRENGTH - Plantar-flexors

  • Sit with your right / left leg extended. Holding onto both ends of a rubber exercise band or tubing, loop it around the ball of your foot. Keep a slight tension in the band.

  • Slowly push your toes away from you, pointing them downward.

  • Hold this position for __________ seconds. Return to the starting position slowly, controlling the tension in the band.

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

STRENGTH - Plantar-flexors, Standing

  • Stand with your feet shoulder width apart. Place your hands on a wall or table to steady yourself, using as little support as needed.

  • Keeping your weight evenly spread over the width of your feet, rise up on your toes.*

  • Hold this position for __________ seconds.

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

*If this is too easy, shift your weight toward your right / left leg until you feel challenged. Ultimately, you may be asked to do this exercise while standing on your right / left foot only.

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, add ____________________ at the end of the towel.

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

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.

  • Return to the starting position slowly, controlling the tension in the band.

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

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.

  • Return to the starting position slowly, controlling the tension in the band.

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