Can Orthotics Have An Impact On Tarsal Tunnel Syndrome?

Dianne I. Mitchell, DPM, and Paul R. Scherer, DPM

What One Study Revealed About The Diagnosis And Treatment Of Tarsal Tunnel Syndrome

In 1998, Mondelli and coworkers performed pre- and post-treatment nerve conduction studies on patients with tarsal tunnel syndrome in order to evaluate the success, or lack thereof, in treating tarsal tunnel syndrome.11 Initially, they found three things: 1) slowing sensory conduction velocity in the plantar nerve in 77 percent of feet; 2) distal motor latency was delayed in 55 percent of feet; and 3) electromyography (EMG) showed neurogenic changes in 45 percent of feet soles.

   At the follow-up, which only included 23 patients (24 painful feet) of the initial 59 patients, these patients had gone through various treatments.11 Treatments included surgical release (6), injection therapy (9), anti-inflammatory therapy (2), physical therapy (2) and no therapy or treatment (5). The results were interesting. Five surgical patients had improved sensory conduction velocity and distal motor latency while one worsened. Of the nine injection therapy patients, only six patients repeated the neurologic testing. There was improved sensory conduction velocity in two feet and improved distal motor latency in four feet while the remaining patients showed no changes. The anti-inflammatory treatment group included two feet with now normal sensory conduction velocity and distal motor latency tests. The physical therapy patients reported good outcomes and unfortunately did not repeat nerve testing at follow-up. Finally, of the five feet with no treatment, three patients returned for nerve testing and two had improved sensory conduction velocity and distal motor latency while one worsened.

   The authors concluded that surgery should be limited to patients with space-occupying lesions.11 They stated that one should not operate on patients with trauma-induced or “idiopathic” tarsal tunnel syndrome because with time or conservative care, these patients can recover. The study did not fully define conservative care or physical therapy. The authors went on to say that one should always confirm the diagnosis of tarsal tunnel syndrome with “electrophysiological evidence of delay of the distal conduction of the plantar nerves.” This will allow separation of the diagnosis of tarsal tunnel syndrome from other causes of foot pain, such as plantar fasciitis, deformity and vascular disease.

A Closer Look At Conservative Care Options

Conservative care options for tarsal tunnel syndrome may include but are not limited to many modalities.3,5,6,8 The literature reports include rest; weight loss if the patient is obese; compression stockings if the patient has swelling; oral pain medication such as narcotics, anti-inflammatories or nerve pain medication; vitamin B6 injection therapy; or even local anesthesia with or without the addition of cortisone to the impingement site. Other conservative care options include avoidance of activities that irritate or trigger pain, or physical therapy geared to decrease inflammation and strengthen both the intrinsic and extrinsic muscles in the foot. Other options may include immobilization with a cast, walking boot, or ankle brace; a heel lift to attempt to decrease tension on the nerve by placing the ankle in a slightly plantarflexed position; and functional foot orthotics.

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