Both stretching and strengthening exercises are important for rehabilitation and preventing of Tarsal Tunnel syndrome. Here we explain stretching and strengthening exercise for treating and preventing Tarsal tunnel syndrome.
Stretching the calf muscles is particularly important as tight gastrocnemius and soleus muscles (which make up the calf muscle group) can increase overpronation. 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, sit on a couch or table with your legs out straight in front.
Feet should be hanging just over the edge of the couch.
If the therapist applies gentle pressure to your foot, to initiate a stretch, an angle of 90 degrees should be possible without needing to force it.
Your 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 as tight gastrocnemius muscles are more common, and can contribute to developing tarsal tunnel syndrome.
Gastrocnemius muscle stretch
Stretching the gastrocnemius muscle must be done with the leg kept straight when being stretched.
One method is to place 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 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 downward pressure onto the plantar fascia. It acts like a deep tissue massage to help stretch the fascia.
Tarsal tunnel syndrome exercises should include strengthening exercises for the muscles responsible for supination. This helps prevent overpronation. In particular, strengthening the tibialis posterior muscle as well as eccentric strengthening of the peroneal muscles should help to slow the movement of pronation.
Isometric 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.
Slowly return to the start position, rest and repeat 10-20 times. Begin with only 10 reps and gradually increase.
This can be performed every day provided it is pain-free.
To make it harder, start with the band under increased tension by shortening the section being used.
Tibialis posterior strengthening
Resisted eccentric Inversion
To work the peroneal muscles that 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 is a functional exercise more closely related to normal everyday 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 progressed by increasing the duration of the walks.