Tarsal Tunnel Syndrome

Just as we have the carpal bones of our wrist that form a tunnel in which artery and nerve and tendons may become impinged and cause pain and numbness, the tarsal bones of the ankle along with a retinaculum, connective tissue, can also impinge the tibial nerve. Tarsal Tunnel Syndrome is no where near as common as carpal tunnel syndrome, but it can be very debilitating to those that endure it

The tibial nerve branches off of the sciatic nerve just above the knee. it courses along the posterior tibia bone and then behind the medial ankle just before it splits to provide sensation and muscle control to the bottom of the foot. When the tibial nerve is impinged both motor and sensory nerves are compromised resulting in numbness, tingling and pain. 

Common causes of Tarsal Tunnel Syndrome are injury from trauma or repetitive use.  Endurance athletes are susceptible as are those diagnosed with RA or diabetes. Prolonged inflammation around the ankle can be a factor as well.

Therapy follows rehab protocol, NIRS. NORMALIZE the tissue. Reduce inflammation and pain. INCREASE flexibility. RESTORE proper movement. STRENGTHEN. Severe cases may require surgery especially if there is an obstruction such as a cyst or bone spur present.

Today, 2-4-19, I had a client presenting with all of the afore mentioned symptoms.
"The bottom of my foot is numb and if I walk a short distance it hurts from the bottom of my foot up into my calf".

I do not diagnose or prescribe. I do assess and make judgement as to whether to treat or refer. After testing for muscle strength and sensory perception I ruled out the spinal cord, disc or nerve root as a factor. I proceeded to massage and scrape above the ankle. He had multiple adhesions as well as trigger points that duplicated both the pain and numbness. I scraped just above and behind the medial ankle along the achilles tendon and up into the soleus muscle of the calf. This produced significant blushing with petichiae bruising indicating fascial adhesions. I also scraped along the peroneus longus and brevis muscles on the lateral leg which produced the same. He was already feeling relief from the numbness.

I proceeded to massage deep to the soleus muscle on three muscles that serve the foot and toes. These were rather painful, but with each passing minute it became not only tolerable but "it actually feels good, like it's releasing something".  I had him stand and walk. He was amazed at the relief. He was amazed at the result of scraping as he looked in the mirror. "my wife is going to freak when she sees what you did to me". He reported that most of the sensation loss had returned to normal.

I showed him the actions of the muscles involved, pointing the toes and inverting/ supinating the ankle. I asked him to think of what he does that prolongs that shortening or uses it repetitively that could cause such shortening and tightening of those muscles. He knows that he sleeps face down with toes pointed and he drives a lot. "oh yeah, I forgot to tell you I broke my ankle in a motorcycle accident when I was a teenager". 

We made a plan for avoiding such positions I instructed him how to use a tennis ball in place of my hands to massage the muscles of his leg. We then went outside in order to 
stretch the calf on a curb.

I do not expect to see him again. Not for these symptoms.