This document describes a case of tarsal tunnel syndrome in a 27-year old male who plays soccer and football. He sprained his ankle during a soccer game, which led to pain and numbness in his plantar medial heel. A positive Tinel's test confirmed tarsal tunnel syndrome. Symptoms include shooting pain, numbness, tingling, or burning in the rear of the ankle and plantar medial heel, which may extend to the toes. The proposed treatment plan focuses on reducing swelling in the tarsal tunnel area over 3 weeks. Treatments include ice, soft tissue massage, myofascial release, nerve flossing, and stretching exercises to relax and strengthen muscles in the leg and foot.

1. 1
fredric carson
manuel portillo
I. Injury or condition - Tarsal tunnel syndrome or Posterior Tibial Neuralgia is a compression,
or squeezing, on the posterior tibial nerve (whichprovides sensation to the bottom of the foot.) that
produces symptoms anywhere along the pathof the nerve running from the medialmalleolus into the foot.
A. Having flat feet or fallen arches, which can produce strain or compression on the tibial
nerve
B. Swelling caused by an ankle sprain which then compresses on the nerve
C. Diseases such as arthritis or diabetes which can cause swelling, thus resulting in nerve
compression
D. An enlarged or abnormal structure, such as a varicose vein, ganglion cyst, swollen tendon,
or bone spur, that might compress the nerve
II. Mechanism of injury or etiology -
Male, age of 27 has tarsal tunnel. He received tarsal tunnel because he plays a lot of
sports such as soccer and football. He was playing soccer and sprained his ankle trying to
receive a ball and took a bad step. He felt pain around the plantar medial heel. went to the
doctor and had a positive tinel test..
III. signs and symptoms -
A. Shooting pain, Numbness, Tingling or burning sensation usually in the
retromalleolar(Situated behind a malleolus) and sometimes in the plantar medial heel and
may extend along the plantar surface as far as the toes
B. management plan -
Phase3 - Acute
Goals: reduce swelling in tarsal tunnel area and encourage muscles
of the leg to relax. Strengthen the muscles of the medial leg ankle and foot to
correct any over soupanation of the foot.
Estimated length of time of phase (ELT): 3 weeks
Soft Tissue Rehabilitation:
● ice pack on tarsal tunnel region for duration of cold cycle (cold, pain
stinging numbness) 15 min.
● static pressure on the gastrocnemius to encourage relaxation -
2min.
● spreading of the gastrocnemius - 2min
● myofascial release medial leg - 2 min
● trigger point along the flexors to eliminate myofascial trigger points
and associated tension in the flexor muscles whose tendons pass
through the tarsal tunnel.
●
● Stretch the tibialis anterior by inverting & dorsiflexing the foot
passively - presets of 10 sec holds
● Stretch the peroneus longus evert in plantarflex - presets of 10 sec
holds
● Stretch the tibialis posterior & the peroneals by bringing them into
pronation passively - presets of 10 sec holds

2. 2
fredric carson
manuel portillo
● compression gastrocnemius - 30 sec
● myofascial release on tarsal tunnel
● Floss the posterior tibial nerve-
a. bring knee to 90°
b. Extend to 180°
c. Evert the foot
d. Dorsiflex the foot
e. repeat twice passively and actively
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