Medial Calcaneal Nerve Entrapment

Medial calcaneal nerve

Medial calcaneal nerve entrapment has similar symptoms to that of tarsal tunnel syndrome. Pain radiates from the inside of the ankle, under the heel and into the arch of the foot.

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Symptoms

Symptoms of a medial calcaneal nerve entrapment include:

  • A burning pain below the medial malleolus (bony bit on the inside of your ankle).
  • Pain may radiate under the sole into the arch of your foot.
  • Activities such as running will usually aggravate the condition and there may be tenderness over the medial malleolus.

Assessment tests

A positive sign for tinels test will be seen on examination.

This involves tapping the foot with a rubber hammer just behind the medial malleolus.

Repeated tapping will reproduce symptoms of burning pain, known as Tinel’s sign.

What is Medial calcaneal nerve entrapment?

Medial calcaneal nerve entrapment is compression or pinching of a nerve in the foot.

Anatomy

Nerves of the foot

The Medial Calcaneal Nerve is a branch of the Posterior Tibial nerve which is involved in cases of Tarsal Tunnel Syndrome. Symptoms of the two injuries are often very similar and so they may be easily confused.

Causes

overpronation

Overpronation – this is when your foot rolls in (flattens) too much when you walk or run. As a result, the medial calcaneal nerve becomes trapped.

Footwear – pressure from shoes, especially poorly fitting or inadequate sports shoes can also cause the nerve to become pinched or impinged. Read more on choosing running shoes.

Treatment for Medial calcaneal nerve entrapment

Rest – treatment should initially consist of rest from aggravating activities

Ice – apply ice or cold therapy to reduce pain. Ice should not be applied directly to the skin as it may cause ice burns. Use a wet tea towel or a commercially available cold wrap. Cold can be applied for 10 to 15 minutes every hour if the injury is painful reducing as required to 3 or 4 times per day.

Medication – a doctor may prescribe anti-inflammatory medication to reduce pain and inflammation.

Electrotherapy – such as ultrasound can help reduce pain and inflammation. Ultrasound is application of high-frequency sound waves (above normal hearing), which can reduce pain and inflammation.

Ankle exercises – once symptoms settle down then a full rehabilitation program of ankle mobility and strengthening exercises can begin but they should only be done if pain allows.

Ankle exercises

Injections – If conservative treatment fails then a corticosteroid injection may be administered and in rare cases which fail to respond to treatment surgery may be indicated to decompress the nerve.

References & further reading

Counsel PD, Davenport M, Brown A et al. Ultrasound-guided radiofrequency denervation of the medial calcaneal nerve. Clin J Sport Med 2016;26(6):465–470

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