The strengthening exercises below may help towards building a Tarsal Tunnel rehab program.
Tarsal tunnel syndrome exercises should include strengthening the muscles responsible for supination to help avoid pronation. In particular, strengthening the tibialis posterior and eccentric strengthening of the peroneal muscles, this will then help to slow the movement of pronation.
Resisted ankle inversion
To begin strengthening the tibialis posterior, the muscle can be contracted without movement of the ankle / foot. The patient sits on the floor with their ankle just to the outside of a chair or table leg. Alternatively a partner or friend can apply resistance with their hand. The patient then attempts to move the foot inwards against the resistance. This contraction can be held for 5-10 seconds, before resting and repeating 5-10 times. Start at the bottom of this range and gradually increase time and reps.
Resistance band ankle inversion
A resistance band is tied around the foot with the other end attached to a fixed point. The foot is turned inwards against the resistance of the band. lowly return to the start position, rest and repeat 10-20 times. Begin with only 10 reps and gradually increase. This can be performed everyday provided it is pain free. To make it harder, start with the band under increased tension by shortening the section being used.
Resisted eccentric Inversion
To work the peroneal muscles to help control pronation or eversion of the foot, a partner is needed. The partner tries to push the foot into pronation and the patient resists this movement, slowing and controlling it. The force and speed the pronation (eversion) force is applied with can be slowly increased as strength improves.
Heel toe walking
Heel toe walking is a functional exercise more closely related to normal every day movements. Walk slowly across the floor from the heel with the toes pointing up then as the foot rolls forward push up onto the toes. Continue walking with a heel toe action until you feel the muscles working. Variations on this exercise include walking only on the heel or walking only on the toes. Exercises can be done twice a day and progress by increasing the duration of the walks.