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 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

Tinels test involves tapping the foot just behind the medial malleolus with a rubber hammer. The test is positive if repeated tapping reproduces burning pain symptoms.

What is Medial calcaneal nerve entrapment?

Medial calcaneal nerve entrapment is the 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

Rest from all aggravating activities.

Cold therapy

Apply ice or cold therapy for 10 minutes every hour initially. Reduce frequency to 3 to 4 times per day as your symptoms improve.

Do not apply ice directly to the skin as it may cause ice burns. Use a wet tea towel or a commercially available cold wrap.

Medication

Anti-inflammatory medication for example Ibuprofen reduces pain and inflammation. Always check with your doctor before taking medication.

Electrotherapy

Your physio may use ultrasound to help reduce pain and inflammation. Ultrasound is the application of high-frequency sound waves (above normal hearing), which can reduce pain and inflammation.

Ankle exercises

Once symptoms settle down begin a full rehabilitation program. Ankle mobility and strengthening exercises are important, but only if pain allows.

Ankle exercises

Injections

Your doctor may give a corticosteroid injection.

Surgery

In rare cases, if conservative treatment fails then you may need surgery 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 Sports Med 2016;26(6):465–470

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