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  • Q&A with Australian Health Practitioners

    What are the treatments for Tarsal Tunnel Syndrome?

    I contracted this condition two months ago. I am on Lyrica and have had cortisone treatments. Both are not assisting the condition (which feels like electric shocks in my heel).I have also tried physiotherapy but this aggrevated the condition. Would acupunture assist and where do I find these practicioners?
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  • 1

    Thanks

    Stewart Hayes

    Podiatrist (General)

    Stewart Hayes has experience as a podiatrist specialising in the area of “Sports Podiatry” since 1994 (the specialty dealing with biomechanical, sporting & overuse complaints … View Profile

    As with most conditions you should follow the standard treatment protocols.  For Tarsal Tunnel Syndrome (TTS), these would be -

    - In the acute phase - Rest, Ice, Compression, Elevation (does not apply to you as 2 months is no longer acute)

    - Anti-inflammatory medication. You are using a drug for neuropathic pain which is not helping.  Cortisone is also an option, but again didn't work with you.

    - Correcting foot mechanics. Overpronated feet will impinge on the posterior tibial nerve, which is the nerve involved in TTS.  Orthotics (not rigid ones) should be made from a non-weightbearing cast or scan with the foot held in its ideal position.  A weightbearing scan or impression often results in the foot moving into its pronated position which is biomechanically incorrect.

    - Rehab the ankle & subtalar joints to increased movement and improve muscular control around those joints.  Stiff joints or dysfunctional muscles can impact on the amount of pronation.

    - Nerve conduction studies may help to determine where the entrapment is or rule out TTS completely.

    - Finally, after all conservative measures have failed, surgery may be an option, but that is for a specialist Foot & Ankle Orthopaedic Surgeon to comment on.

    Regards,

    Stewart

  • TarsalTunnel

    HealthShare Member

    Thanks Stewart, I have now had further radiology tests only to find it is Baxters Nerve Entrapment (first branch of the lateral plantar nerve). Ouside of having an operation to release the nerve, would anyone have any recommmendations on non-invasive treatments? I have orthotics which are not helping and taking Lyrica to reduce the number of spasms. Would anyone recommend radial shockwave therapy or acpunture as alternates for this condition?   

  • Sandra McFaul

    Physiotherapist

    Do you suffer from chronic lower back pain or neck pain? Based in SYDNEY, Sandra is 1 of ONLY 15 Physiotherapists in Australia with ADVANCED … View Profile

    Stewart has made some good suggestions above. 

    My question to you is:
    “Are your orthotics custom made?” 

    There are “off the shelve” orthotics which can be heated with a “heat gun” and then molded to your foot. 

    But then you could get orthotics that are made specifically for you.  You would get a cast of your foot made and the orthotics are made just for your foot shape and size. 

    Podiatrists make orthotics but there is also the profession of “Orthotists.”  You may want to check out http://www.aopa.org.au/  to find an orthosist near you.

    My other question is “Are you stretching your calf muscle reguarly.”  This is typically a muscle that gets tight in many people.

    Regards.
    Sandra McFaul

  • 1

    Thanks

    Stewart Hayes

    Podiatrist (General)

    Stewart Hayes has experience as a podiatrist specialising in the area of “Sports Podiatry” since 1994 (the specialty dealing with biomechanical, sporting & overuse complaints … View Profile

    Hi,

    It seems that non invasive measures aren't helping, there isn't much else you can do, so you may need to see a specialist Foot & Ankle Surgeon. 

    I have little experience with radial shockwave therapy, so will not comment.

    As for acupuncture, by all means give it a go.

    Good luck

    Stew

  • 5

    Thanks

    Jacqueline Kan

    Podiatrist (General)

    Cheltenham Podiatry offers excellence in all areas of footcare.From corns, callouses, fungal nails to sports injuries, Diabetic foot care, ingrown nails and orthotics. Full gait … View Profile

    You could try a slump stretch,Im sure sandra would know of this. Basically, this forces  the whole nervous system from the spinal cord to all the smaller branches in the foot to slide.The nerve tissue should be able to slide to a small degree in a normal situation. When you have nerve entrapement the nerve gets caught in tissue ,gets jammed so instead of sliding backwards and forwards as it normally should, it gets caught and thus sends incorrect electrical impulses,causing your pain.

    Sit on ground with knees straight, hold  hands behind your back, bring chin into your chest, get someone to hold your affected foot back in a dorsiflexed and abducted position-similar to a pronated position(this will put the first branch of lateral planter nerve in an elongated stretched position) during the exercise. Then bending at the hip , bring your whole torso as close to your thighs as possible keeping your knees straight,and come back to the sitting position. Continue bouncing up and down for about 10 min.When you come to the position of your torso close to your thigh dont hold it there, but keep bouncing just make sure you go down as far as you  can. Its normal to feel tightening and pulling under knees and buttocks. Everytime you bounce your trying to force the affected nerve to slide thru the tissue and clear it from where its catching. I have ocassionaly had remarkable results with this with nerve entrapments of the foot. Sorry about the long notes,tried to find utube video but they were all different versions of the strech that may not work. If you have an existing lower back complaint their is another technique that you will have to do, just let me know.Sometimes when you do this ,you may feel the nerve pain inthe foot,dont worry if you do, its a good sign. I would try this for 2-4 weeks. Nerves are one of the slowest tissues in the body to heal so you need patience.good luck, if this does not work the shock wave is definately worth a try

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