St Albans Osteopathy Blog

Tarsal Tunnel Syndrome

Tarsal Tunnel Syndrome, like Carpal Tunnel Syndrome in the wrist, is a compression of the nerve inside the tunnel. It is less common than its counterpart in the wrist and is sometimes simply wrapped into the foot neuropathy diagnosis. The pressure can come from injuries resulting in deformities, inflammation of the protective sheath, tumours, or other impingements on the nerve. The compression on the nerve interferes with the signals sent through the nerve, causing pain and other neuropathy in the foot.

Treatment

Reducing pain and inflammation:

  • Rest. This may mean complete rest, staying off the foot with the aid of crutches or it may mean simply modifying normal training activities. It really depends how severe the pain and injury is. Switching from running to swimming or cycling for a while may be sufficient.
  • NSAID’s (non-steroidal anti-inflammatory drugs) such as ibuprofen may help in reducing inflammation and pain.

Correction of biomechanical dysfunction

  • If the athlete over pronates or the foot rolls in when running or walking then this may aggravate the condition. If they were to rest and not correct any possible causes then the injury is likely to return when normal training resumes.
  • For mild over pro nation a motion control shoe may be sufficient. These are running shoes which have a dual density midsole. The harder material on the inside of the sole helps prevent the foot from rolling in.
  • For greater pronation control an orthotic device may be required.
  • There are 23 bones in the feet. Each bone articulates with at least one other bone. All these joints need to function normally. Your osteopath will be able to evaluate these joints and correct any dysfunction.

Exercises

Stretching

Gastrocnemius muscle stretch

  • This is done by placing the heel of the back leg on the floor and stretching forwards.
  • Hold for ten seconds, repeat three to five times and repeat the set three times a day.
  • Gradually hold the stretch for longer (up to 45 seconds).

Soleus muscle stretch

  • In addition to the above stretch this one will stretch the Soleus muscle lower down in the back of the leg.
  • The same principles apply but it is important to bend the stretching leg at the knee.
  • This takes the Gastrocnemius muscle which attaches above the knee out of the stretch.

Plantar fascia stretch by rolling

  • The plantar fascia can be stretched by rolling it over a round or cylindrical object such as a ball, bar or rolling pin.
  • Roll the foot repeatedly over the ball applying downwards pressure.

Stretching on a step

  • Stretch by standing on the edge of a step and allowing the heel to drop.
  • Hold for at least 15 seconds.
  • You should feel a gentle stretch.

Plantar fascia stretch

  • This can be done by sitting and using your hand to pull the bottom of the foot towards you.
  • Hold the stretch for about 30 seconds.
  • Repeat five times and aim to stretch 3 times a day.

Strengthening

Static toe flexion

  • With the feet flat on the floor, press the toes downwards into the floor.
  • Do not allow them to curl, or the ankle to move whilst performing the exercise.
  • Hold for the count of 3, repeat 10 times.
  • Perform this exercise 3 times a day if possible.
  • Progress the exercise by holding the contraction for longer.

Spreading the toes

  • Place feet flat on the floor.
  • Spread the toes as far as they will go and then return them together.
  • Repeat this 10 times, rest and the perform a further 2 sets of 10 repetitions.
  • Aim to repeat this exercise 3 times a day.

Toe lifting

  • Place feet flat on the floor and try to lift each toe up in turn.
  • Aim to keep the others flat on the floor - not easy, is it?
  • Perform three sets of each toe.
  • Try to perform this exercise twice a day - at least once.

Pencil lifting

  • Pick up a pencil in the toes.
  • Hold for count of 6, repeat 10 times.
  • Aim to perform this exercise 3 times a day.
  • An alternative version of this is to repeatedly scrunch up a towel in the toes.

Walking on the toes

  • Simply walk about on tip toe.
  • Do not wear shoes but perform the exercise barefoot.
  • Aim for 8 sets of 15 to 20 seconds with 20 seconds rest between.
  • Complete the exercise 2 times a day.
  • Progress by increasing the duration of the walks.

 Walking on the heals

  • As above but walk on the heals.
  • Aim for 8 sets of 15 to 20 seconds with 20 seconds rest between.
  • Complete the exercise 2 times a day.
  • Progress by increasing the duration of the walks.
June 9th 2019
 

Philip Bayliss, St Albans Osteopathy, 43 Thames Street, Christchurch 8013 ☎️ 03 356 1353