Can Orthotics Have An Impact On Tarsal Tunnel Syndrome?
Kirby developed the medial skive in order to offer an additional supinatory torque in the medial half of the heel cup portion of the orthotic.12 The medial skive can range from 2 mm (mild deformity correction) to 6 mm of correction depending on the degree of calcaneal eversion. Finally, in order to stabilize this device, one would add a rearfoot post using a firm material such as polypropylene or high durometer ethylene vinyl acetate (EVA) with no motion. Additionally, in reference to a study we mentioned earlier, compartment pressures decrease with the foot not only held in subtalar joint neutral but also slightly plantarflexed through the ankle.10 With this in mind, clinicians may also consider a heel lift to aid in decreasing traction on the nerve and add a top cover for comfort.
At the start of this article, we asked if orthotics can impact tarsal tunnel syndrome. After looking at the anatomy of the region, the symptoms patients present with, the mechanics of the hindfoot that can irritate or place the nerve on traction, and what the literature says about tarsal tunnel syndrome, we believe that functional foot orthotics can certainly impact tarsal tunnel syndrome.
Unfortunately, current literature only suggests the success of these devices but using logic and knowledge of foot and ankle mechanics, we believe that a properly prescribed orthotic from a properly molded foot can result in a device that will aid in pain reduction for patients with tarsal tunnel syndrome.
Perhaps a future study, following the paper by Mondelli, could first identify patients with tarsal tunnel syndrome using clinical parameters and employ pre-treatment and post-treatment nerve conduction studies to evaluate patients multiple months after use of functional foot orthotics.11 This would certainly evaluate whether these devices removed tension on the nerve to rid patients of their symptoms and also potentially allow repair of the nerve.
Dr. Mitchell is a Fellow of the American Academy of Podiatric Sports Medicine and is board certified by the American Board of Podiatric Medicine. She is in private practice with Mercy Medical Group, Inc. in Sacramento, Calif.
Dr. Scherer is a Clinical Professor at the Western University of Health Sciences College of Podiatric Medicine at Pomona, Calif. He is also the CEO of ProLab Orthotics/USA.
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3. Banks AS, Downey MS et al. McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery, volume two, third edition. Lippincott Williams and Wilkins, 2001, pp. 1266-1278.
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10. Trepman E, Kadel NJ, Chisholm K, Razzano L. Effects of foot and ankle position on tarsal tunnel compartment pressure. Foot Ankle Int. 1999; 20(11):721-726.
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12. Kirby KA. The medial heel skive technique: improving pronation control in foot orthotics. J Am Podiatr Med Assoc. 1992; 82(4):177-178.
For further reading, see “Rethinking Tarsal Tunnel Syndrome” in the December 2004 issue of Podiatry Today or “Inside Insights On Evidence-Based Orthotic Therapy” in the February 2007 issue.
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