Summer weather brings more walking, running, flip-flop wearing, and foot pain! Recently a large number of patients have presented to the clinic with the idea that they may have plantar fasciitis. It is important to recognize that pain at the bottom of the foot does not always mean the plantar fascia is to blame.
The tibial nerve begins behind the knee and runs down into the foot behind the medial malleolus, or bump on the inside of the ankle. As it passes behind this bony bump, it is tethered down by a band of tissue called the “flexor retinaculum” along with some other tendons and blood vessels. The passageway under the flexor retinaculum is called the “tarsal tunnel” and usually the tibial nerve branches into the medial and lateral plantar nerves, within the tunnel which innervate and give sensation to the bottom of the foot.
Tarsal tunnel syndrome results from an irritation of the tibial nerve within the tunnel. Any irritation caused by compression or friction of the nerve can result in inflammation and in more chronic situations the nerve can actually become shorter and tighter and even scar down in places. This means that instead of sliding easily through tissue during every day foot movements the nerve gets pulled on and rubbed against which causes more inflammation and scarring1.
Symptoms of tarsal tunnel syndrome vary widely depending on both the patient and the severity of nerve compression and/or irritation. Typically parasthesia in the territory of the distal branches of the tibial nerve occurs, causing tingling, shooting pain, burning, or aching along the tibial nerve and into the plantar nerves1. If only one of the plantar or calcaneal nerves are affected, the dysfunction can be called distal tarsal tunnel syndrome. Prolonged walking or standing can exacerbate the symptoms, and sometimes pressure over the nerve and tarsal tunnel can be painful. Tarsal tunnel syndrome can be both idiopathic or post-traumatic1.
Physical therapy treatment for tarsal tunnel syndrome depends on why the nerve is being compressed. Initially, treatment may be focused on reducing swelling and inflammation. A proper assessment would dictate what faulty foot position or weakness is causing the nerve irritation, and through manual therapy and exercise the therapist would work on correcting the cause of the problem.
Because foot pain can be caused by a wide variety of structures, it is always worth getting assessed so that any dysfunction can be treated before it becomes a chronic issue. Don’t assume that all pain on the bottom of the foot is due to the plantar fascia. If you have pain on the bottom of your foot, contact us today to book in with one of our experienced physiotherapists who will help you determine the root of the pain and help you treat it so that it goes away for good!
Written By: Dalyce Lees, Physiotherapist
1. Antoniadis G, Scheglmann K. Posterior Tarsal Tunnel Syndrome. Diagnosis and Treatment.
Dtsch Arztebl Int. 2008 Nov; 105(45): 776–781. doi: 10.3238/arztebl.2008.0776