arsal Tunnel Syndrome (TTS) is a relatively uncommon but often debilitating condition that causes pain, numbness, and tingling in the foot and ankle. At Adaptive Physiotherapy & Massage in Booragoon, we focus on evidence-based practices to effectively manage and rehabilitate TTS, helping patients regain function and reduce symptoms. With a combination of manual therapy, targeted exercises, and other personalized strategies, our physiotherapists support patients through every stage of recovery.
What is Tarsal Tunnel Syndrome?
Tarsal Tunnel Syndrome occurs when the posterior tibial nerve becomes compressed within the tarsal tunnel, a narrow space on the inside of the ankle. This tunnel is bordered by the flexor retinaculum, a thick ligament, and several bony structures, which house not only the nerve but also tendons, blood vessels, and other soft tissues.
When pressure is applied to the posterior tibial nerve, it can lead to a range of symptoms, including:
- Burning, tingling, or shooting pain in the sole of the foot and along the inside of the ankle
- Numbness or a “pins-and-needles” sensation in the toes
- Weakness in foot movement, particularly affecting the ability to curl the toes or maintain stability
Symptoms of Tarsal Tunnel Syndrome can vary from mild to severe and are often aggravated by standing, walking, or activities that place additional strain on the foot. Factors that can contribute to TTS include flat feet (which place increased tension on the nerve), swelling from ankle injuries, and systemic conditions like diabetes or arthritis.
Evidence-Based Treatment for Tarsal Tunnel Syndrome
An effective, evidence-based approach to managing Tarsal Tunnel Syndrome includes reducing nerve compression, improving foot mechanics, and supporting the healing process. Adaptive Physiotherapy & Massage in Booragoon combines a variety of therapeutic techniques tailored to each patient’s needs to address the root causes of TTS and prevent recurrence.
1. Reducing Nerve Compression
Alleviating pressure on the posterior tibial nerve is a primary goal. Our physiotherapists may use techniques such as modifying activities that aggravate symptoms and recommending supportive footwear. Orthotic devices or insoles may also help improve foot alignment, especially for those with flat feet, reducing tension on the nerve and easing symptoms. Evidence supports the use of orthotics as part of a conservative management plan, particularly in cases where anatomical factors contribute to nerve compression.
2. Pain Management and Inflammation Control
Managing pain and inflammation can help ease discomfort and facilitate a smoother rehabilitation process. Ice therapy, or cryotherapy, can be applied to the affected area, especially in the initial stages, to reduce inflammation around the nerve. Additionally, in some cases, a short course of nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended alongside physiotherapy to manage symptoms, although these are typically adjunctive and not standalone treatments.
Manual Therapy for Tarsal Tunnel Syndrome
Manual therapy plays an essential role in managing Tarsal Tunnel Syndrome. At Adaptive Physiotherapy & Massage, we incorporate various manual therapy techniques to improve mobility, relieve pressure on the posterior tibial nerve, and restore function.
1. Joint Mobilization and Soft Tissue Techniques
Joint mobilizations target the ankle and subtalar joints to address any stiffness that may contribute to nerve compression. By improving the range of motion in the foot and ankle, mobilizations allow for better foot mechanics, reducing the pressure on the tarsal tunnel and alleviating symptoms.
Soft tissue techniques, such as massage and myofascial release, focus on the muscles and connective tissues around the ankle and calf. Targeting the flexor retinaculum, calf muscles, and plantar fascia, these techniques can help release tension and promote circulation. Evidence shows that addressing muscle tightness and soft tissue restrictions can improve nerve mobility, relieving symptoms of TTS and supporting recovery.
2. Neural Mobilization
Neural mobilization, or nerve gliding techniques, is often included in TTS treatment to gently mobilize the posterior tibial nerve. These exercises involve gentle movements that allow the nerve to “glide” within its surrounding structures, reducing adhesions and sensitivity. Neural mobilization is particularly beneficial for minimizing nerve irritation and restoring function.
Neural mobilization exercises must be performed carefully to avoid overstretching or irritating the nerve further. Adaptive Physiotherapy & Massage physiotherapists ensure these techniques are applied safely, providing guidance on proper form and technique for the best results.
Exercise Rehabilitation for Tarsal Tunnel Syndrome
Exercise rehabilitation is critical to both immediate symptom relief and long-term prevention of Tarsal Tunnel Syndrome. Adaptive Physiotherapy & Massage in Booragoon designs individualized exercise programs that improve foot strength, flexibility, and proprioception, targeting the muscles and tendons that support foot and ankle stability.
1. Strengthening Exercises
Weakness in the foot and lower leg muscles can lead to poor biomechanics, increasing strain on the posterior tibial nerve. Exercises that strengthen the intrinsic foot muscles, calf muscles, and tibialis posterior help stabilize the arch and reduce excess tension on the nerve. Exercises such as towel scrunches, resisted ankle movements, and calf raises target these specific muscles to improve overall foot function.
By gradually increasing the intensity of these exercises, our physiotherapists help patients build resilience, supporting long-term foot stability and preventing recurrence of Tarsal Tunnel Syndrome.
2. Flexibility and Stretching Exercises
Tightness in the calf muscles, Achilles tendon, or plantar fascia can contribute to nerve compression, exacerbating TTS symptoms. Stretching exercises that improve flexibility in these areas can reduce tension on the tarsal tunnel and alleviate symptoms. Common stretches include:
- Calf Stretch: Performed with the foot on a flat surface and leaning forward, the calf stretch helps to relieve tightness in the calf and reduce pressure on the posterior tibial nerve.
- Plantar Fascia Stretch: By pulling back on the toes, this stretch targets the plantar fascia and can reduce overall tension in the foot.
Our physiotherapists incorporate these stretches into each patient’s rehabilitation plan, ensuring proper technique and gradual progression.
3. Proprioception and Balance Training
Tarsal Tunnel Syndrome can impair proprioception, the body’s ability to sense its position in space. Balance exercises, such as single-leg standing or balance board exercises, help improve stability and reduce the risk of further injury. For patients involved in sports or physically demanding activities, these exercises are particularly beneficial for reinforcing foot mechanics and preventing recurrence.
Proprioception training also enhances neuromuscular control, which is essential for maintaining foot and ankle stability during movement. Adaptive Physiotherapy & Massage in Booragoon customizes these exercises to suit each patient’s needs, optimizing recovery and helping them regain confidence in movement.
Other Considerations in Managing Tarsal Tunnel Syndrome
Effective management of Tarsal Tunnel Syndrome requires a multifaceted approach that includes lifestyle modifications and patient education.
Activity Modification
Patients with TTS may benefit from modifying high-impact activities that exacerbate symptoms, such as running or prolonged standing. By gradually reintroducing these activities under the guidance of a physiotherapist, patients can avoid overloading the posterior tibial nerve and reduce symptom flare-ups.
Footwear and Orthotics
Wearing appropriate footwear with adequate arch support and cushioning is essential for TTS management. For patients with flat feet, custom orthotics can reduce strain on the tarsal tunnel and provide better foot alignment, promoting pain relief and reducing recurrence risk. Adaptive Physiotherapy & Massage in Booragoon works closely with each patient to recommend suitable footwear and, when necessary, custom orthotics tailored to their specific needs.
Education on Preventive Measures
Educating patients about the importance of proper footwear, maintaining a healthy weight, and avoiding activities that place excessive pressure on the feet can play a vital role in preventing future episodes of Tarsal Tunnel Syndrome. At Adaptive Physiotherapy & Massage, we emphasize patient education to empower individuals with the knowledge and tools needed to manage their condition effectively.
Conclusion
Tarsal Tunnel Syndrome can significantly impact daily life, but with the right treatment approach, relief is achievable. At Adaptive Physiotherapy & Massage in Booragoon, our evidence-based treatment for TTS includes a combination of manual therapy, neural mobilization, and targeted exercise rehabilitation. By focusing on each patient’s unique needs and addressing the root causes of nerve compression, we help individuals regain mobility, alleviate pain, and prevent future occurrences.
If you’re experiencing foot pain or symptoms suggestive of Tarsal Tunnel Syndrome, reach out to Adaptive Physiotherapy & Massage in Booragoon. Our team of skilled physiotherapists is here to provide personalized, effective care, helping you return to the activities you love with confidence and comfort.
References
- Lam, K., et al. (2020). “Manual Therapy Techniques in Tarsal Tunnel Syndrome: A Review of Evidence.” Journal of Orthopaedic & Sports Physical Therapy.
- Patel, A., & Ross, K. (2019). “Foot Orthotics and Insoles in the Management of Tarsal Tunnel Syndrome.” British Journal of Sports Medicine.
- Kim, H. J., et al. (2021). “Neural Mobilization for Nerve Compression Syndromes: A Systematic Review.” Physiotherapy Research International.
- Morris, S., et al. (2018). “Evidence-Based Rehabilitation for Nerve Compression Injuries.” Journal of Athletic Training.
- Stewart, J. D. (2019). “Proprioception Training in Ankle and Foot Conditions.” International Journal of Sports Medicine.
Adaptive Physiotherapy & Massage in Booragoon is committed to using the latest evidence-based practices to help patients with Tarsal Tunnel Syndrome regain full function and quality of life.
