Tarsal tunnel syndrome (TTS) is a painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel producing pain and sometimes numbness distal to the compression.
Tarsal tunnel syndrome generally results from excessive traction or pressure on the tibial nerve. Studies indicate tibial nerve traction increases with eversion of the foot and collapse of the medial arch. This abnormal motion can be minimized by supporting the heel in a neutral or vertical position. Mild ankle plantarflexion and support of the medial arch may also be helpful in reversing the pathomechanics.
Clinical Goal for Orthotic Treatment
The goal of the orthoses used to treat TTS is to decrease tibial nerve traction by controlling heel eversion, plantarflexing the foot and providing medial arch support.
To prescribe this device check “Tarsal Tunnel Syndrome” under the Pathology Specific Orthoses section (Part A) of the prescription form.
- Polypropylene Shell – semirigid
- Deep Heel Cup
- A deep cup helps limit heel eversion
- Wide Width
- A wider width through the arch increases surface area under the arch preventing arch collapse.
- Minimum Cast Fill
- Minimum cast fill creates an orthosis that conforms closely to the arch of the foot and helps prevent arch collapse
- Medial Heel Skive – 4mm
- The medial heel skive creates a greater force medial to the axis of the subtalar joint helping to reduce excessive STJ pronation and heel eversion
- Inversion – 2 degrees
- Inversion of the positive cast increases arch height in order to prevent medial arch collapse
- Rearfoot Post
- Heel Lift – 4mm
- The heel lift encourages ankle joint plantarflexion
An orthosis prescribed for the treatment of tarsal tunnel syndrome should decrease heel eversion, prevent medial arch collapse and encourage mild ankle plantarflexion. The orthosis described is designed to decrease tibial nerve traction and is based on the current medical literature.
- Fujita I, Matsumoto K, Minami T, et al: Tarsal tunnel syndrome caused by epineural ganglion of the posterior tibial nerve. J Foot Ankle Surg 43(3):185, 2004
- Gundring WH, Shields B, Wenger S: An outcome analysis of surgical treatment of tarsal tunnel syndrome. Foot Ankle Int ;24(7):545, 2003
- Havel P, Ebraheim N, et al: Tibial nerve branching in the tarsal tunnel, Foot Ankle 9:117, 1988.
- Keck C: The tarsal tunnel syndrome. J Bone Joint Surg :44A:180, 1962
- Kinoshita M, Okuda R, Morikawa J, et al: The dorsiflexion-eversion test for diagnosis of tarsal tunnel syndrome. J Bone Joint Surg 83A(12):1835-9, 2001
- Kirby KA: The medial heel skive technique: Improving pronation control in foot orthoses. JAPMA 82:177, 1992.
- Labib SA, Gould JS: Heel pain triad (HPT) the combination of plantar fasciitis, posterior tibial tendon dysfunction and tarsal tunnel syndrome: Foot Ankle Int 23(3):212, 2002
- Marui T, Yamamoto T, Akisue T, et al: Neurilemmoma in the foot as a cause of heel pain: A report of two cases: Foot Ankle Int 25(2):107, 2004
- Mondelli M, Morana P, Padua L: An electrophysiological severity scale in tarsal tunnel syndrome. Acta Neuro Scand 109(4):284, 2004
- Raikin SM, Minnich JM: Failed tarsal tunnel syndrome surgery. Foot Ankle Clin. 8(1):159, 2003
- Reade B, Longo D, Keller M: Tarsal tunnel syndrome: Clin Podiatr Med Surg, 18(3):395-408, 2001
- Trepman E, Kadel NJ: Effect of foot and ankle position on tarsal tunnel compartment pressure. Foot Ankle Int 20(11):721, 2000