This example rehabilitation program for tarsal tunnel syndrome has been separated into basic stages. These stages are: reducing pain and inflammation, correcting the causes of the injury, stretching and strengthening exercises.
Most athletes will not require surgical treatment for this injury. The following guidelines are for information purposes only. We recommend seeking professional advice before starting any rehabilitation.
Aims of tarsal tunnel syndrome rehab
- Reduce pain and inflammation.
- Correct any biomechanical dysfunction such as overpronation.
- Stretching & Strengthening.
- Gradual return to full fitness.
Reducing pain and inflammation
Rest is needed for tarsal tunnel syndrome to settle down. Depending on how bad the injury is, this may simply mean modifying training activities to avoid weight bearing or reduce the number of miles normally run. Or it could mean complete rest and putting no weight on the foot, with the use of crutches. Your doctor or sports injury professional can advise on individual cases, but as a general rule, if it hurts either at the time, afterwards or the next day then do not do it. For many people, switching from running to cycling or swimming for a while may be sufficient.
Apply ice or cold therapy but not directly to the skin as it may burn. Ice can be wrapped in a wet tea towel or you can use a commercially available ice pack or wrap which has been designed for the purpose.
NSAID's (non steroidal anti inflammatory drugs) such as ibuprofen may be prescribed which may help in reducing inflammation and pain. Always check with a doctor before taking any medication. Asthmatics should not take ibuprofen.
This stage of rehabilitation can last from 48 hours to a week depending on how bad the injury is and how much rest the foot gets. Stretching exercises can be done as soon as pain allows.
Correction of biomechanical dysfunction
If the athlete overpronates or the foot rolls in when running or walking then this may aggravate tarsal tunnel syndrome. If they were to rest and not correct any possible causes then the injury is likely to return when normal training resumes.
For mild overpronation a motion control shoe may be sufficient. These are running shoes which have a dual density midsole. The harder material on the inside of the sole helps prevent the foot from rolling in. For greater pronation control, an orthotic device may be required. These can be purchased off the shelf from most chemists or more specifically made to measure by a sports injury therapists.
Stretching and strengthening exercises
The muscles of the back of the lower leg and the foot require stretching. This is particularly important if dorsiflexion of the foot (pushing the foot and toes upwards) reproduces pain. Stretching can be done three times a day, and should be done on a regular basis for a period of weeks - not just days....click here for more on stretching exercises.
Strengthening the small intrinsic muscles of the foot and the arch supporting muscles should be concentrated on....click here for more on strengthening exercises.
Surgery for tarsal tunnel syndrome
Surgery may be indicated when the diagnosis is definite and if the athlete has endured several months of problems without a response to the conservative treatment above.
Diagnosis is firm when the following factors are present: foot pain and numbness; a positive tinels test (tapping on the nerve produces pain); and a positive electrodiagnostic testing ( testing for nerve injury). Following surgery, symptoms may improve after 6 weeks, although complete recovery may take 6 months or more.