Lateral plantar nerve entrapment has symptoms similar to other heel injuries including pain on the inside of the ankle and heel. It is caused by compression of the lateral plantar nerve. Here we explain the symptoms, causes, and treatment.
Lateral plantar nerve entrapment symptoms
Lateral plantar nerve entrapment has similar symptoms to Plantar fasciitis and Tarsal tunnel syndrome.
- Pain is felt over the inside of the ankle and heel.
- Pressing in (palpating) along the inside of foot and ankle, especially near the heel bone is likely to reproduce symptoms.
- Sometimes pain may radiate into the middle three toes.
- Numbness in the heel is not normally a symptom plantar nerve entrapment.
A sports injury therapist may use tinels test to help diagnose a nerve entrapment. However, Tinel’s sign is not normally present in cases of Lateral plantar nerve entrapment. So that is one way of differentiating it from other nerve impingements such as Tarsal tunnel syndrome.
- This involves tapping the nerve just behind the medial malleolus (the bony bit on the inside of the ankle) with a rubber hammer.
- If this triggers pain or tingling in the foot then the test is positive.
A doctor may inject the area with a local anesthetic to help with diagnosis.
- If the pain is temporarily eliminated because of the pain-killing injection then this is a good indication that lateral plantar nerve is causing the problem.
- Nerve conduction tests may also be used to help diagnose a plantar nerve entrapment.
Lateral plantar nerve anatomy
The lateral plantar nerve can become trapped, or compressed between the abductor hallucis muscle and the quadratus planus muscle along the inside of the foot. As a result, the compressed nerve causes pain.
The plantar nerve branches off the posterior tibial nerve after it has passed through a passage called the tarsal tunnel, just below the medial malleolus (bony bit on the inside of the ankle).
It branches into two parts:
- The medial plantar nerve (medial meaning inside)
- The lateral plantar nerve (lateral meaning outside).
The lateral plantar nerve passes down the inside of the heel and under the foot to ‘innervate’ the outside two toes. The medial plantar nerve splits off to innervate the middle three toes.
Patients who overpronate, where the foot rolls in too much and flattens during walking or running are more susceptible to lateral plantar nerve entrapment.
This is because of the additional pressure applied to the inside of your foot when running.
Ice – apply ice or cold therapy to help with pain and inflammation.
Rest – and avoid using the foot as much as possible as continuing to walk or train will not allow the injury to recover. If your injury is minor then adjusting your training methods by reducing running mileage, or substituting swimming or cycling for running until the injury has healed may be enough. For a more severe injury, complete rest may be advised.
Medication – a doctor may prescribe anti-inflammatory medication or NSAID’s (e.g. ibuprofen). Always check with a doctor before taking medication. Do not take ibuprofen if you have asthma.
Taping – To help rest the foot, the arch of the foot can be supported with a simple arch taping technique.
- Arch taping is an excellent way of relieving symptoms and can often instantly relieve pain.
- However, it will only last for a few hours or so, depending on how much you are on your foot and body weight. This is because the tape itself starts to stretch and give slightly. Therefore, it may need to be applied regularly until symptoms resolve but many people notice an immediate improvement.
Orthotic insoles – may also be prescribed to correct any biomechanical problems of your foot. This includes overpronation where your foot rolls in (flattens) too much. Orthotics are shaped insoles which are worn inside your shoes. They should be worn all the time, not just when playing sport!
Depending on the type of correction needed, and the depth of your pockets these can either be bought ‘off the shelf’ in specialist shops and pharmacies. Or they can be bespoke made by a qualified sports injury professional or Podiatrist. Seek professional advice if you are not sure.
Corticosteroid injection – may be administered if conservative treatment is unsuccessful. Corticosteroids are anti-inflammatory drugs which can be either injected locally or taken orally as tablets.
Injected corticosteroids are more commonly used in musculoskeletal conditions. This is because it concentrates the dose at the site of injury, therefore reducing the risk of side-effects. Corticosteroid injections do have a reputation of being painful, however, this can be limited with the use of a local anaesthetic.
The aim of injecting corticosteroids is to reduce pain and inflammation sufficiently to enable exercises to be done and should be used in conjunction with physical therapy and correction of biomechanical factors.
Surgery – if all of the above options have failed, then surgery may be indicated to release the pressure on the nerve. This is called a surgical release.