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Do you have numbness and tingling across the bottom of the foot?  Furthermore, do you have burning pain in the ankle or foot?  It may be often at the sole or first toe. Your pain and paresthesias (numbness a tingling) probably came on insidiously (gradually).  And you do not have any associated low back or leg pain. You may also have noticed weakness in your foot. Lastly, your symptoms are worse by prolonged standing, walking, or running.  These are all symptoms of Tarsal Tunnel Syndrome.

In one study that evaluated patients with tarsal tunnel syndrome, 45 % reported numbness, 39% reported pain, and 16% reported both.  Read on to learn about Ankle and Foot Pain from Tarsal Tunnel Syndrome: Chiropractic Can Help.

Cause

The posterior tibial nerve may be stretched or compressed in the tarsal tunnel.  This is a tunnel formed by the flexor retinaculum (band of thickened deep fascia around tendons), calcaneus (large bone forming the heel), distal tibia (shin bone), and malleolus (inner and outer boney protuberances of ankle).

Contents of the tunnel include: the tendons of the posterior tibialis (muscle in posterior compartment of the lower leg), flexor digitorum longus (also located in posterior compartment muscles of lower leg), and flexor hallucis (muscle goes from calf to 1st toe) and the posterior tibial artery, vein, and nerve. 

Anatomy of the Tibial Nerve

Firstly, the tibial nerve is one of two main terminal branches of the sciatic nerve.  And the sciatic nerve is the largest nerve in the human body.

Secondly, the tibial nerve originates from the L4-S3 spinal nerve roots and provides motor and sensory innervation to most of the posterior (back part) leg and foot.

Thirdly, the tibial nerve descends from the popliteal fossa (space behind knee joint) into the posterior compartment of the leg. It passes deep to the fibular and tibial heads of soleus muscle (a calf muscle found between knee and heel).  Fourthly, it runs vertically through the deep layer of the posterior (back) compartment of the leg, along with the posterior tibial blood vessels. The tibial nerve provides innervation to the surrounding muscles in this area.

Fifthly, the tibial nerve exits next at the ankle joint. It passes behind the medial malleolus (boney protuberance at inner ankle) to enter the sole of the foot.  Here it supplies innervation to most of the intrinsic (deep) muscles and skin.

Sixthly, past the tarsal tunnel, the tibial nerve gives off its terminal branches, the medial and lateral plantar nerves.  These nerves continue to supply motor and sensory innervation to the plantar foot.

 

Pronation of the Foot

Hyperpronation (excessive inward rotation of the foot during gait) is often the cause of tarsal tunnel syndrome.  This could be due to tightening of the flexor retinaculum or arch of the abductor hallucis muscle. This muscle is located on the inner border of the foot and bends the big toe and moves it out to the side. However, trauma and the subsequent swelling may also cause entrapment of the tibial nerve. 

There may also be a chronic tenosynovitis of the posterior tibial or flexor digitorum longus tendons.  This occurs near the malleolus (prominent bones at ankle) as areas that can compress the tibial nerve.  These fascial restrictions may be a primary cause. However, it is necessary to rule out ganglions, myositis ossificans, exercise compartment syndrome, and tumors.

 

Examination

Your doctor may order a nerve conduction study in a difficult unremitting case.  However, usually patients are diagnosed by the physical (orthopedic, neurological etc.) examination.

 

Dr Natalie Meiri adjusts a patient's ankle
Dr Natalie Meiri adjusts a patient’s ankle

 

Treatment at Meiri Chiropractic for Tarsal Tunnel Syndrome

First, soft tissue techniques will be rendered to the contracted fibrotic muscle and collagen at entrapment sites. Second, chiropractic adjustments (chiropractic manipulative therapy) to the foot, ankle and associated restricted joints along the kinetic chain is important.

Third, Therapeutic exercise will be given for stretching and strengthening.

Lastly, if trauma or swelling is involved, ice, compression, elevation, and physical therapy modalities is utilized to reduce swelling. Also, an orthotic and/or correction of shoes may be necessary if there is pronation of the foot.

 

Are your suffering from ankle or foot pain from Tarsal Tunnel Syndrome?

We offer excellent Chiropractic care for Tarsal Tunnel Syndrome. At Meiri Chiropractic, we spend the time necessary to examine, diagnose and treat every neuromusculoskeletal condition and various ailments you have. Indeed, Chiropractic is a holistic and natural way to not only treat foot and ankle pain, but to keep your body in its best working condition. We have been offering effective chiropractic care in West Palm Beach since 2006. Many of our patients reviews note our excellence. Call us today at 561-253-8984 to make an appointment or to find out more about Ankle and Foot Pain from Tarsal Tunnel Syndrome: Chiropractic Can Help.

 

Meiri Chiropractic

5601 Corporate Way, Ste#102

West Palm Beach, FL 33407