Tarsal tunnel syndrome

 Tarsal tunnel syndrome:

 is the compression of an important nerve that runs through your ankle and into your foot. It’s possible to develop tarsal tunnel syndrome after spraining your ankle, overusing your feet, or developing arthritis or diabetes

Causes:-

Tarsal tunnel syndrome (TTS) is caused by compression of the posterior tibial nerve as it travels through the tarsal tunnel. Compression of the posterior tibial nerve can cause pain, tingling or numbness in the foot

Symptoms:

Burning sensations.

Numbness.

Tingling or “pins and needles” sensations.

Weakness in your foot muscles

Diagnosis:

🔹Tinel’s test:

 Physical therapist gently taps your tibial nerve. If you experience pain or tingling that reproduce your symptoms, it may point to TTS.

🔹Dorsiflexion – Eversion Test:  

Place the patient’s foot into full dorsiflexion and eversion and hold for 5-10 seconds

The results are that it elicits the patient’s symptoms

🔹Electromyogram (EMG): 

This two-part test uses an electrical impulse to measure your nerve and muscle function.

🔹MRI: 

MRIs use magnets and radio waves to take detailed images of soft tissue and bones inside of your body. Your healthcare provider may order an MRI to evaluate an injury or nerve damage or a mass putting pressure on your tibial nerve

  

◾Gait Analysis:

Assess for abnormalities (excessive pronation/supination, out-toeing, excessive inversion/eversion, antalgic gait, etc.)

◾Sensory Testing

Test light touch, 2-point discrimination, and pinprick in the lower extremity

Deficits will be in the distribution of the posterior tibial nerve

◾Palpation:

Tender to palpation in between the medial malleolus and Achilles tendon

Painful in 60-100% of those affected

◾Range of Motion (ROM):

Focus on ankle and toe ROM

 Physical therapy

⚫Heel-toe raises

Using the back of a chair or counter for support, lift the heels off the floor to stand on the toes.Hold for 5 seconds before slowly lowering back down to the floor.Repeat the exercise 15 times.Do two sets, with a 30-second rest between each set.

As the injured foot becomes stronger, try standing on the injured foot only.

⚫Balance exercise

Stand beside a chair, using it for support if needed, with the injured foot furthest from the chair.Stand on the injured foot and slightly bend the knee.Bend forward from the waist and reach forward with the hand furthest from the chair.Repeat 15 times for two sets.

Reach the hand furthest from the chair across the body, toward the chair.

Repeat 15 times for two sets.

⚫Calf stretch

Stand and face a wall with the hands placed on the wall at eye level.Take a lunge position by placing the injured foot slightly behind with the heel flat on the ground and the other leg slightly forwards with a bent knee.Turn the back foot inwards slightly.Gently lean towards the wall until there is a stretch in the back calf.

Hold in this position for 15–30 seconds.

Return to the start and repeat 3 times.

Repeat the entire exercise several times a day.

⚫Soleus muscle stretch

Lean forwards pressing the back heel into the ground until a stretch is felt

If it is not possible to feel a stretch, then place something underneath the toes to raise the front of the foot.Or put the ball of the foot up against the wall and push the knee forwards

Bending the knee takes the Gastrocnemius muscle, which attaches above the knee, out of the stretch

⚫ Ball Rolling 

Stretching the plantar fascia is by rolling it over a round or cylindrical shaped object such as a ball, rolling pin or can of soup. The can of soup can be placed in the freezer to include a cold therapy effect as well.

Roll the foot repeatedly over the ball applying downward pressure onto the plantar fascia. It acts like a deep tissue massage to help stretch the fascia.

⚫Resistance band ankle inversion

A resistance band is tied around the foot with the other end attached to a fixed point

The foot is turned inwards against the resistance of the band.Slowly return to the start position, rest and repeat 10-20 times

Begin with only 10 reps and gradually increase

This can be performed every day provided it is pain-free. To make it harder, start with the band under increased tension by shortening the section being used

⚫Ankle rotation – 

Just like all other parts of the body, exercising the ankles helps to keep them strong. For this exercise, sit on a chair and shake your ankles for a few seconds. After this, rotate the ankles gently clockwise about four to five times then repeat the same with counterclockwise motion.

⚫The pencil lift – 

The pencil lift is done by placing a pencil on the floor then picking it up with the toes and holding it for about ten seconds. You should repeat this exercise, relaxing after every round.

⚫TOE FLEXORS/PLANTAR FASCIA STRETCH

Sit on a chair or on the floor for this exercise.

Bring the foot you would like to stretch in towards you by bending your knee.Place the heel of one hand along the tips of all of your toes.Run your fingers around the ball of your feet and under your sole.Using your fingers and your hand, pull all of your toes back towards you.Be sure to not forget about your little toe.

Hold this position

Electrotherapy

TENS

Ultrasound therapy 

Acupuncture 

Shock wave diathermy 

K tapping 

Orthotic management:-

Braces, casts or splints:

 A cast or splint keeps your foot in place to encourage nerve healing. If you have flat feet or severe symptoms, your healthcare provider may recommend a brace to reduce pressure on your feet. Orthotics: You may use custom-made shoe inserts (orthotics).

Injection therapy: 

For very painful or disabling symptoms, a doctor may inject anti-inflammatory medication, such as corticosteroids and local anesthetics, directly into the nerve.