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Tarsal Tunnel Syndrome

It is a narrow space on the inner aspect of the ankle behind the ankle bone. The tunnel is covered by a
thick ligament-like soft tissue called the flexor retinaculum and contains structures such as nerve, artery,
veins and tendons. The base of the tunnel is formed by the underlying bones of the foot.

Tarsal tunnel syndrome

The nerve that passes through the tarsal tunnel is the posterior Tibial nerve. Compression due to constant pressure or repeated pressure causes damage to the nerve. As a result, symptoms like pain, numbness, tingling, sharp shooting pain or electric shock-like sensation can occur at the inner aspect of nerve or in the sole. If the damage is severe, symptoms may also be felt along the upper part of the nerve and may lead to weakness of the small muscles of the foot. Aggravation of pain or tingling happens due to any activity that increases the compression on the nerve. Tibial nerve can also be affected because of flat feet, any fractures in the area, bony overgrowths, arthritis of the ankle joint, etc.

Rehabilitation of Tarsal Tunnel Syndrome

Tarsal tunnel syndrome is managed both conservatively and surgically depending on the cause of the problem. Rehabilitation forms an important part of both conservative and surgical management. While managing conservatively, reducing pain and inflammation is the main focus in the acute stage. This is done by soft tissue releases, posterior tibial nerve mobilization, using electrotherapy modalities and supporting the part. Support to the nerve and inner arch of the foot is provided using Kinesio tape, insoles and footwear modifications if required. Light nerve mobility and foot muscle exercises are introduced in the acute stage. Gentle flexibility exercises assist in increasing mobility of the affected area.

Later, as the pain subsides, gradual strengthening exercises, especially for the tibialis posterior muscle, are done. Progressing nerve mobility exercises will help desensitize the posterior tibial nerve. To correct the biomechanics of the whole lower extremity muscles controlling functional activities in weight-bearing are addressed which includes core and gluteal muscle training. Since the ankle is a weight-bearing joint, functional re-education in a weight-bearing position like standing, walking, stair climbing is introduced in later stages of recovery. Proprioceptive and balance training aid in functional re-education. Post-surgical rehabilitation follows a phase-wise protocol with importance on protecting the surgical site in the initial phase. After about 3 weeks light and gentle exercises are initiated with appropriate precautions in mind. During the course of recovery, exercises and functional re-education are progressing on a weekly basis and good recovery is expected by the end of 3 months.

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