The following stretching exercises may be used in the rehabilitation of tarsal tunnel syndrome.
In particular stretching the calf muscles is important as tight gastrocnemius and soleus muscles which make up the calf muscle group can increase over pronation. A good starting point is to assess the flexibility of the calf muscles. Exercises should always be done pain free.
Testing calf muscle flexibility
To assess gastrocnemius muscle flexibility the athlete sits on the couch with the legs out straight in front and feet handing just over the edge of the couch.
If gentle pressure is applied to the foot, and angle of 90 degrees should be possible without needing to force it. The therapist should feel a natural resistance even before the athlete feels a stretch.
The Soleus muscle is tested in the same way but with the knee bent. This relaxes the large gastrocnemius calf muscle leaving the soleus still stretched. It is rare that the soleus muscle will be tight, however tight gastrocnemius muscles are more common and can contribuite to developing tarsal tunnel syndrome.
Gastrocnemius muscle stretch
Stretching the gastrocnemius muscle must be done with the leg being stretched kept straight. One method is by placing the heel of the back leg on the floor leaning against a wall. If you cannot feel a stretch move the back leg further back. Hold for ten seconds, repeat three to five times and repeat the set three times a day. Gradually hold the stretch for longer, up to 45 seconds. Another way to stretch the gastrocnemius muscle is by dropping down off a step. This is more suitable for athletes with very flexible calf muscles.
Soleus muscle stretch
Stretching the soleus muscle which is lower down at the back of the leg must be done with the leg being stretched bent at the knee. Lean forwards pressing the back heel into the ground until a stretch is felt. If it is not possible to feel a stretch then place something underneath the toes to raise the front of the foot, or put the ball of the foot up against the wall and push the knee forwards. Bending the knee takes the Gastrocnemius muscle which attaches above the knee out of the stretch.
Plantar fascia stretch
The plantar fascia is a band of tissue under the sole of the foot which runs from the heel to the forefoot. Stretching the plantar fascia can be done by pulling the great toe and forefoot upwards. It should be possible to see and feel the plantar fascia being stretched under the foot. Hold the stretch for about 30 seconds. Repeat five times and aim to stretch 3 times a day. Remember stretching is a long term process. It will need to be maintained long after you feel the injury has healed.
Another way of stretching the plantar fascia is by rolling it over a round or cylindrical shaped object such as a ball, rolling pin or can of soup. The can of soup can be placed in the freezer to include a cold therapy effect as well.Roll the foot repeatedly over the ball applying downwards pressure onto the plantar fascia. It acts like a deep tissue massage to help stretch the fascia.