Tarsal Tunnel Syndrome (TTS) is much the same as Carpal Tunnel Syndrome…except the Tarsal Tunnel is in your ankle.
Here’s a recent email I received from Tom:
“I came across your group on Facebook, about Carpal Tunnel Syndrome Relief. I have the leg version of this complaint, Tarsal Tunnel Syndrome and am about to have an operation to rectify it. Do you have any information on Tarsal Tunnel? I ask because I’ve not managed to find much about it other than the operation doesn’t have a very high success rate. I’m clinging to the hope that my op DOES work.”
Here’s my response to Tom:
“My best resource is ‘Myofascial Pain and Dysfunction, The Trigger Point Manual, Vol. 2, The Lower Extremeties‘ by Travell & Simons, MD’s. These 2 volumes may be (and should be) on your surgeon’s or physician’s bookshelf. Here is my translation of what they have to say about TTS in a nutshell.
Regarding surgery:
The doctors said that surgery to release the tibial nerve and the medial and lateral plantar nerves as they passed through and deep to (behind; more inside) the abductor hallucis muscle was successful in 9 of 10 TTS release surgeries. That means 90% were successful. Sometimes, part of the abductor hallucis is removed.
The doctors said: “The possible (likely) role of myofascial TrPs in the abductor hallucis was apparently not considered in these patients with heel pain.” What does that mean? The doctors Travell & Simons were aware that muscles and soft tissues (not bony tissue) cause a huge amount of our pain and other symptoms. It means that if Travell or Simons were your doctor, they would be looking for trigger points as the cause of your pain before they considered surgery. (TrPs = trigger points.)
What causes tarsal tunnel syndrome?
Running, jumping and shoes that are too tight–not wide enough–can be a cause. Also, in 2 cases, the abductor hallucis muscle was 3 times larger than normal, and in one case, had an additional muscle belly. In those 3 cases, the extra-large muscle pressed on the nerves.
What are trigger points?
If you go to Carpal Tunnel Pain Relief, and scroll down to ‘Categories’ and scroll to “Triggers and Triggers Points” you will find articles describing trigger points and their causes. Basically, they are extremely irritable spots in soft tissue or muscle that “fire” or cause pain elsewhere, sometimes at a very far distance from the trigger point.
Like everything else, trigger points are caused by something. The ‘something’ has to be corrected (I’m thinking posture here rather than surgery,) released, or relaxed, as well as the trigger point. Trigger points can be released with manual (hand) pressure by a massage or muscular therapist.
Where is the abductor hallucis muscle?
Basically the muscle is in the arch of your foot, on the side that is closest to your other foot.
What causes the TTS symptoms?
A ‘syndrome’ is a collection of symptoms. Symptoms are your pain, numbness, tingling, headache, etc. Everything has a cause: Symptoms are caused by ‘something.’
When the abductor hallucis muscle becomes taut it presses, or entraps, the nerves that pass deep to it. ‘Taut’ is not the same as ‘tight.’ Taut = a rope being pulled on from both ends. When a muscle is taut, it is being pulled on from both of its’ ends. The rope, or muscle, cannot relax because it is being pulled too tightly.
‘The Rehabilitation Specialist’s Handbook‘ says TTS is a compression of the nerves in the ankle, and it does mention some reasons that could cause compression in the area. It does not, however, suggest that muscles might be the cause of the symptoms.
Actually, little is understood by the medical field about trigger points and the roles of muscles in soft tissue pain because that’s not something most doctors learned in medical school. (Nor did we in school.) And while muscles are the usual cause of symptoms, of course, sometimes there are other causes like a bone or blood vessel deformity or a crushing injury.
So where would the cause actually be?
In the muscles on the top of your foot as well as the abductor hallucis. Muscles act like a labor union: If one goes out on strike, others follow. Rarely do muscles act alone. All of the surrounding area, foot and leg, will be likely taking part in the action. That means that all of the muscles should be massaged or manually treated.
Who would do the treatment?
I’d recommend a neuromuscular massage therapist, especially one trained in the Paul St. John Method of NMT. They seek to eliminate causes of pain, rather than just treat the symptom.
There are probably some doctors who would use Travell & Simons’ method of ‘spray & stretch’ to release the muscle and restore normal movement to the ankle and toes. A doctor will spray a vapocoolant on the tight areas which anesthesizes them and then stretch the muscles and joints.
Travell (deceased) & Simons are Medical Doctors, not massage therapists, so they did ‘doctorly’ stuff rather than too much soft tissue massage. Regardless, trigger points can be released both ways.
A stretch that is mentioned in the “Trigger Point Manuals” involves extending the great toe, and massaging the muscles in the arch deeply and slowly toward the great toe to stretch and release them.
My personal, first choice for a treatment would always be the least invasive. That means I’d rather see whether manual therapies would help before I’d try surgery.”
And, I wished Tom a good resolution of his Tarsal Tunnel Syndrome.
i have been tossed around from doctor to doctor for 2 years now because they can’t decide if it’s my back thats causing my foot to be numb, weak, and crampy or if it really began in my foot. I was first diagnosed with L5 radiculopathy but when things were getting worse i went to different doctors. So now 2 years later i find out that i have tarsal tunnel syndrom from an old injury in my foot. The pain in sevear and causes my whole back to cramp up because of the way i walk with no feeling in half my foot. Everything i read tells me that its a tissue build up compressing the nerves and if treated early can be fixed through physical therapy/medicain. is it to late to be physically rehabilitated?
Hi Stephanie,
By now you have hopefully received my response by email. I’m glad you finally got a diagnosis. I suggested in the email several things you can do to start the process of healing. It’s really too bad that most of the medical profession doesn’t pay much attention to the roles of muscles in pain syndromes. That’s not something that gets taught much in medical school. That’s why there are muscle specialists. One of the things I suggested beside massage and ice is to buy a copy of the blue trigger point book that is for sale on the right hand side of this site. The muscles that are responsible for causing TTS symptoms are shown and release treatment is demonstrated. The book is for do-it-yourself pain relief. You have a smart body that wants to be well. Right now, it just needs a little help from you. By educating yourself, you have the best chance of getting better, no matter which route you take. Since numbness is involved, and nerves heal very, very slowly, it may take quite a while until you get all of your sensation back. In the meantime, you might start a whole body movement program just to help the rest of your muscles get back into balance, too. I wish you the best and please feel free to contact me again.
Kathryn Merrow
The Pain Relief Coach
i was wondering if i have tarsal tunnel syndrome or if its something else. Normally my feet don’t hurt, but when i excercise (especially jumping excercises) i get severe pain at the bottom of my foot (in the arch area). The pain is often really bad and this is preventing me from doing a lot of the exercises that i like. I also know that the pain is not caused by bad shoes, because it happens with all shoes, even running shoes. Does this sound like tarsal tunnel syndrome?
Hi Alicia, A “syndrome” is a bunch of symptoms. It’s possible that in your case you may need orthotics (arch supports) to support your arch while you jump/exercise.
It’s also possible that tight calf muscles are causing this pain in your arch. It may or may not be tarsal tunnel syndrome but here are some suggestions: Deeply massage the arch of each foot, looking for tender areas and applying pressure to them. Search the whole arch area and press into the areas where the bones and muscles meet (ball of foot and heel.)
You can “massage” your calf by rolling it on a tennis ball as you apply pressure, or on your opposite knee. If you find tender areas that generally means tight muscles that need pressure or massage to “release” or relax them.
You can also take the time when your muscles are warmed up but before you begin your exercise to stretch your calves. Please look for a new article on this question in a few days. Thank you for writing!
I have been to several doctors with my heel pain. Two of them diagnosed me with a heel spur and set up surgery in January. But yesterday I went to another doctor who told me I did not have heel spurs, but tarsel tunnel, which I had never heard of. He is sending me to a neurologist in Jan to have a nerve test on my leg and foot. In 1987 I had an accident in which my leg was severly hurt. The new doc said this could be the root of pain in my heel. Does tarsel tunnel feel like sharp pains in your heal?
I have had a cortisone shot but felt no relief. What would you recommend?
Hi Tommy,
Tarsal tunnel symptoms can be felt as pain, burning or tingling on the sole (bottom) of the foot. You may also feel it on the side of the ankle (the side where your arch is.) Symptoms are usually worse as the day goes on and can usually be relieved by elevating your foot, rest or massage. We are not talking sweet gentle massage here–You want deep pressure into the muscles in the arch of your foot to really get into the muscle.
Injury can cause TTS, possibly because of scar tissue that develops. Flat feet can also develop TTS because walking flat-footed puts a strain on the muscles of the arch. The muscle in the arch of your foot can press on the nerve that causes the TTS symptoms.
I am not a doctor but my first recommendation is always the one that causes the least trauma or change to a body. That would be deep tissue massage and trigger point massage, in your case. (And in most cases.)
Probably 90% of our pain is caused by muscles so that is generally my first plan of attack. On the other hand, sometimes surgery is required, for example, to remove a bone chip. On the other hand, sometimes it LOOKS like a bone chip or other situation when tests are examined but treating the muscles with massage or a cortisone shot relieve the pain of the “bone chip.”
If you have normal strength and movement in your body, hands & arms, you may be able to get deeply into your arch muscles. If you cannot apply enough pressure yourself (if you can’t “hurt” yourself enough) then interview professional massage therapists to find one who is familiar with TTS and can treat it. Go into the “Massage” Category here to learn how to find a massage therapist who can actually help you. You may want to postpone your surgery for a month to give yourself the chance to have your symptoms treated by a massage therapist. You should know within a couple of sessions. Once more I will tell you: Manual pressure into tight muscles will not be comfortable but may make a world of difference!
If you have flat feet, custom orthotics or firm arch supports may give relief and can be used with massage. I hope this gives you some help.
Best,
Kathryn Merrow
The Pain Relief Coach
I have been diagnosed with Tarsal Tunnell Sydrome, I am having an operation to fix it. Can anyone give me some information on what it involves and what is the recovary period please?
Hi Janice, Here is the link to an article that will give you more information about tarsal tunnel syndrome. http://www.podiatrytoday.com/article/3337 Whenever you are cut, your tissues are damaged. It’s an injury like any other injury.
Part of your success will depend on the ability and skill of your surgeon. Part of your successful recovery will depend if the surgeon actually is correct in his diagnosis. Ask lots of questions so you get answers that make you comfortable with your decision.
The surgeon should be able to tell you whether he expects you to have 100% recovery and how long it will take to get there. Seems like most surgeries take up to six weeks to recover. You are paying the surgeon (even if it’s insurance paying) so it’s perfectly fine for you to ask questions.
There may be more helpful information for you in the rest of the comments under this article. In the end, remember it’s your body and you get to make the decisions.
I wish you the best.
Kathryn
Hello,
I read on the wiki site that low back pain can sometimes accompany tarsal tunnel pain. I have cramping, heel tingling and pain, numbness with any excercise, and calf cramping and pain in both feet and legs. I also noticed pain in the extreme low back area that sometimes “runs” down both legs and into my feet. I also have aching sensations from my hips to the knees to the feet.
What is the connection if any, and what should I ask my health providers?
Thanks for your response.
Hi Alena,
Thank you for writing. The symptoms you describe make me think of tight gluteal (buttocks) muscles that are pressing on the sciatic nerves as they run through each buttock.
You can lay on a tennis ball to help relax those gluteal muscles. There are articles about Tennis Ball Therapy at http://SimpleBackPainRelief.com Just scroll through the articles on the right hand side.
The connection could be this: your tarsal tunnel pain is affecting the way you walk and that is causing your gluteals to tighten.
Or it could be this: Your tight gluteal muscles are affecting your feet. It can work either way so treating both areas give the best chance for successfully relieving your tarsal tunnel pain.
I hope this helps.
Kathryn
I have been reading all the past replies adn some fit my symptoms and others do not. I have been diagnosed with Plantar Fascitis as well as TTS. I had a nerve test that showed both feet had the nerves entrapped. In Feb. I had surgery to mix the problem. I am back to walking normal but I still am limping first thing in the morning and would say that it has not fixed the problem yet. My doc said it could take up to 1 year to feel the full effects of the surgery. Besides that I have had dull aching pain in both legs, mostly from the knee down. This apin has been off and on for years but seems to be worse recently. It is keeping me up at night and hurts off and on all day. I do calf stretches and foot stretched 2 times a day. I stand near a wall and stretch each calf. I also stretch my foot and calf with a towel. This feels great but doesn’t seem to help for long. I sometimes wear the Strassburg socks which also feel great but after a few hours my foot falls asleep. I’m wondering if my leg pain is due to TTS or do I have problems with my calf muscles? I am so tired of hurting and not feeling like I can excercise because I’m scared I will pay for it later.
Hi Katie, I apologize for taking so long to reply. My first long-distance guess is that the muscles in your calves are tight. They will cause Plantar Fasciitis and might also entrap nerves. When you have pain first thing in the morning that causes you to limp, that is a clue that your calf muscles are tight.
You are doing the right exercises. You might try doing the stretches more frequently but do them thoughtfully. Pay attention and at the first sign that you are stretching too much, back off.
Also practice actively lifting your toes toward your knees. That will help build up your shin muscles and that will help provide balance between the muscles in the front and back of your lower leg.
I’m guessing that you don’t do things to shorten your calf muscles like wear high heels or do heel lifts. If you haven’t tried massage therapy yet, look for a skilled massage therapist who can treat your calf muscles. A good massage therapist will start by softening the outer layers first and eventually get into the deeper muscles. There may be some discomfort but it will usually feel like ‘good pain.’ Massage is THE most effective to help calf muscles relax.
If your money is short, ask them to do only 1/2 hour and to focus on your calves. No sense getting a nice back rub when your goal is to get rid of the pain in your legs. Check the Category for Massage here and you will find an article about how to find a massage therapist who can actually help you get rid of your calf and foot pain.
My only other thought is varicose veins but I think your doctor would have been aware of this.
I think you are doing a very good job of assessing your own problem. Thank you for writing and I look forward to hearing that you feel better soon. I hope this helps.
Kathryn
The Pain Relief Coach
Hi there Kathryn,
I’ve been reading your posts and I’ve learned alot already about tarsal tunnel syndrome.
My physio-therapist initially thought I had posterior tibial tendonitis but after 2 months of treatment, my tendons/muscles along my shin bone were alot softer and alot less painful when she was doing trigger massage. This made her think that maybe i had tarsal tunnel just because the pain in my arch/ankle and bottom of foot was getting progressively worse. She wrote a letter to my physician asking if she thought he could do some nerve conduction tests…what are your thoughts on that? I’m still doing stretches and strengthening exercises for my calf and arch but i can’t stand to walk for more than 10 min. at a time during the day…..it’s sooo debilitating.
Kathryn, I fractured my ankle a year ago and was never casted for it. My arch has fallen very badly so I have gone to a podiatrist and am wearing good orthotics but they don’t seem to relief my daily pain. It seems that if I have my foot up for most of the day, i don’t have much pain. Are there other specific massage techniques that you can give me….my physio therapist did not want to do too much proding in the arch of my foot and just continued massaging my calf and doing accupunture.
Any suggestions would be sooo much appreciated. I have been suffering with hip and back pain also for the past 6 years and I’m thinking that this is all related.
Thanks again and hope to hear back from you soon!
Sincerely,
Elaine Irvine
Hello Elaine,
Thank you for writing. Remember I am not a doctor or physical therapist but here is my best long-distance guess.
Here’s what I think you are saying: Your foot pain became worse as your shin muscles became more relaxed. This may mean that your calf muscles were proportionately becoming much stronger than your shin muscles because the calf muscles were not being treated.
Tight calf muscles can cause pain in the bottom of the foot. If your therapist is causing discomfort for you when she massages your calves (you said she is massaging your calves near the end of your note) she is likely releasing areas of tightness.
By strengthening your shin muscles and stretching your calves (and/or doing trigger point massage for the calves) you will be getting your lower leg muscles back in balance. They should be about the same tone on every side.
I’m thinking that your suspicion about your hip and back pain being related to your foot and lower leg pain is right on! Muscles in the buttocks (the gluteal muscles) can cause pain lower in the leg and in the foot.
You don’t have to be timid about working in your arch. Feet have lots of muscles and they love being massaged and pressed into.
Did you see this article here? http://simplepainrelief.com/2007/11/05/do-your-feet-and-legs-ache/ It will tell you simple things you can do for your arch muscles.
Here’s the link to the whole Foot Pain category. It includes the tarsal tunnel articles but more, too. http://simplepainrelief.com/category/foot-pain/
Elaine, I hope this helps and that you will be feeling much better quickly!
Kathryn
The Pain Relief Coach
Dear Kathryn,
I am hoping you can explain a recent experience. I sprained my ankle about a week ago while on holiday in France. It was a mild sprain and hurt for about five minutes before I continued to walk on it without a problem After several hours It felt a little tender, so I borrowed a bandage and applied it. It then, rapidly, became more painful. As soon as I arrived back to my accommodation I headed for the ice pack and raised my ankle on a pillow. The pain continued to worsen so I lay down, still with the ice pack bandaged onto my raised ankle. Within an hour My whole leg and ankle were having frequent spasms, I was pale and shivering and in shock from the level of pain.
My daughter went to the pharmacist to purchase an antinflammatory and strong pain killers. My son-in-law went and made an appointment with the local doctor (experienced in sports medicine). One of the medicines my daughter bought was topical and so she removed the bandage to apply it. Within half an hour the pain was less. We assumed it was the pain killers and went to the doctor. He said that it was the application of the bandage which caused the pain. The xrays showed no fracture and I was walking normally on a minimally swollen ankle after 24 hours.
The doctor spoke little English, so I was unable to ask all the questions I needed answered.
Exploring the internet I found the possibility of the problem being caused by pressure on the same nerves which cause tarsal tunnel syndrome. Could you clarify if this could indeed have been the cause of the problem.
Thank you
Wendy
Hi Wendy,
Thank you for your question. Here’s what I suspect.
When your ankle was wrapped it started to swell and that could well have been causing pressure on the nerves that run to the foot (just as you suspect.) It also was causing pressure on the other soft tissues and blood vessels. That would have been a delayed swelling and I’m not sure why that would have occurred.
Or perhaps the wrapping was simply too tight and caused the pressure. Anyway, I am glad you recovered and are back to normal and wish I could give you a better response. 🙂
Best,
Kathryn
The Pain Relief Coach
Hi Kathryn,
My Podiatrist thought earlier this year that I had Plantar Fasciitis. He now thinks it is Tarsal Tunnel Syndrome. I have been reading a lot of articles and am unsure. I have read about how tight calves and back pain can accompany this…And I have both. I get massage therapy twice a month, and my LMT says that my back and my calves are just as tight two weeks later, as though she never even massaged them. My foot pain is in both feet. My whole body is just as tight no matter how frequently I see my LMT. My foot pain gets worse the longer I am on my feet. Massage used to help the pain, but now it doesn’t seem to. Do you have any speculations as to what could be happening? This could be totally unrelated, but I also experience frequent migraines. I just thought I would throw that in there in case it related directly to anything else. Thank you.
Hi Chasity,
Here’s my best long-distance guess: Your massage therapist works on your areas of complaint. The problem with that, if I am correct, is that those areas are just symptoms. The areas that are causing your pain are elsewhere.
Migraines can be (almost always are) postural related.
Ideally, we want soft calves. We want our whole back sides from knees to skull to be strong but not the calves. Do you stand with your knees locked back?
Here’s something to try: Ask your massage therapist to work on your calves and also the FRONT of your thighs, the insides of your thighs, your abdomen, your upper chest and the fronts of your arms, and the front and sides of your neck. If she doesn’t really know how to do that or is not comfortable doing that, you may have to find someone else.
The pressure of a massage should elicit discomfort. On a scale of 1-10, when your therapist is pressing into tight muscles, you should feel that it is about a 7. Less than that is just a nice rub. More than that, your body will not respond as well because it will be resisting the pressure.
All parts of your body are attached to all the other parts. Migraines are usually part of a whole body issue. Walking ‘on your toes’ can cause neck and migraine issues.
Also, Chasity, you must do calf stretches between sessions with your massage therapist. Don’t overdo, but do several times a day.
Thank you for writing and take good care of you and let me know how you are doing.
Kathryn
The Pain Relief Coach
Hi, I had Tarsal tunnel release and Partial plantar fascia release done on my right foot Last Thursday, Sep 1st. i am sure my heel has been traumatized from the surgeries and the tight cast I am sure to be necessary, but how much discomfort is enough on my heel?If I keep in one spot too long, it will hurt a lot, like this kinda of pressure on my heel. I can’t tell what is or what is not normal and I got a full week until I see my doctor again. Any suggestions? Thank you
Hello Marielle,
Yes, surgeries do traumatize tissues. Follow your instincts to keep moving. Sometimes the cast isn’t exactly perfectly comfortably placed.
Surgery isn’t normal so it is difficult to tell whether you are experiencing what you should or not.
Even micro-movements of your toes, foot and leg will help keep your blood and lymph flowing through the area. That will help reduce swelling.
And if it starts bothering you even more, get in contact with the surgeon even if it’s not time yet.
I hope you will soon feel better and that your tarsal tunnel surgery will be hugely successful. 🙂
Kathryn
The Pain Relief Coach
Hello Kathryn!
I have read some of your comments on earlier posts regarding tarsal tunnel syndrome. 2 wks ago I was diagnosed with that and I am devastated by the testimonies I read on other websites re: this syndrome. I actually believe that it is possible I may not walk normally again!! I really want to take the least invasive route. I started having tingling and nerve pain in the heal of my foot a few weeks after I struck my heal very hard on a cement floor. It started off annoying, but in 2 short weeks it has progressed to numbness and tingling in the whole foot after I stand on it for just a few minutes. My podiatrist wanted to inject cortisone into the area but I refused as I have heard that can cause worse problems later on down the road. I think his next step is going to be to put me in a cast or a boot to rest the foot. My question is, if the nerve is actually entrapped, how beneficial is “manual manipulation” to release the nerve? Also should I go get a nerve test done to find out if the nerve is actually entrapped before I go get this massage done? In your experience how effective is massage treatment to the foot to alleviate the symptoms of tarsal tunnel? Would orthotics be something to consider since it may be a pronation issue. Just to give you a little background, I am a nurse on my feet 12 hours a day and when I am at home I am on my feet all day because I have 2 small children… Thanks so much in advance! Heather
Hi Heather,
All good questions and I’m sorry to hear of your injury. As you know, I’m not a doctor. Here are my best thoughts:
1. Cortisone does weaken or soften the tissues but it also reduces the swelling which might take the pressure off the nerve. It could possibly take only one injection. And resting the foot to prevent movement may keep you from irritating the nerve and over time, the swelling will probably reduce on its own. (But casting the foot or giving you a built-up sole will throw your posture off and cause other problems so make sure to get both soles lifted to the same height.)
2. If the nerve is being impinged by bone realigning the bones of your heel could be the answer (Some chiropractors do adjustments of bones in the feet. Some osteopathic doctors also do ‘adjustments.’)
3. If muscles are entrapping the nerve, yes, manual therapy would help. If you get the nerve conduction test done you may get an answer to whether the nerve is being pinched by bone or by muscle/soft tissue.
But know what? Muscles move bones. And massage reduces swelling. So even if the entrapment is in/near/by bone I would have calf/heel/foot massage to reduce any muscles that are ‘too tight.”
4. Sounds like you already know that you need orthotics to support your arches. That will help you in any case. Running shoe stores usually carry a good, sturdy arch support. They are standard sized arches so the one that best fits YOUR foot may be a different size than the shoe you wear. You want an arch that makes you have arches. The problem with custom fitted orthotics is that sometimes they are made to support your dysfunction rather than to create correct support.
I have not had tarsal tunnel but I do have a crazy nerve in the heel of my flat foot (I have only one) and when I wear the arch supports from a running shoe store (They are Carbon Flex inserts) I have no nervy issues.
5. Softening and warming your calf muscles can be done with cold therapy. Cold/ice is generally the drug of choice for nerve pain. Heat for muscles 72 hours after injury. But if you try heat and it feels a bit worse you will know that’s the wrong therapy. I’m going with the ice.
If you relax your muscles with gentle stretching of your calf, icing your calf muscles, massaging them and supporting your arches to help align your heel bones I believe you will have benefit.
I think I got to all of your questions, Heather.
One more thing: I help people get rid of the pain naturally by explaining the HOW and WHY when I can. Conventional medicine pretty much treats symptoms and forgets the roles of muscles in pain syndromes. Rather than focusing on the horror stories be assured that your body will heal. You may need a little help as we discussed above and that’s okay. It can heal and I’m sure it will heal.
You’re welcome,
Kathryn
The Pain Relief Coach
I am a 46 year old woman who is tall and thin. I have always been healthy. About a year and half ago I was suffering with what was diagnosed as Sciatica. After taking oral steriods, I was put in orthotics by a chiropractor. He was also doing weekly adjustments on me. I began experiencing pain in my very flat feet but I continued to wear the orthotics as advised by the chiro. I gradually increased wearing them as he suggested. After about 6 weeks, I stopped wearing them because my feet hurt too much. I also stopped seeing him. I then was diagnosed with Plantar Fasciitis by a Foot and Ankle Orthopedist. He gave me cortisone shots in both feet, physical therapy, and a night splint. I religiously stretched and iced as advised. I did not see any improvement so I began dry needling treatments as well. These treatments really did not help me. My pain began in the arch of my feet. Now it really hurts in my heel and radiates to my whole foot to include numbness and pain in my calves and legs. I have trouble walking and standing. I have also been diagnosed with Small Nerve Fiber Neuropathy which was proven by a skin punch test performed by a Neurologist. I also did not mention that I have been on a round of Lyrica and Cymbalta for nerve pain. I can’t say that these are really helping either. I have also taken Neurontin and Sevilla in the past. I guess I am not sure where to go from here. Could this be Neuropathy, Tarsal Tunnel Syndrome, Sciatica, Plantar Fasciitis or a combination of any of these? Any advice would be greatly appreciated. Thanks.
Hi Caren,
I might suggest it could be any of your guesses either in combination or alone. Tight buttock muscles can cause pain on the soles of the feet. They also cause sciatica sensations.
What would I do? I would start by working on the gluteal (buttock) muscles. If they are the cause, that is an easy fix and you would know pretty quickly. Here are directions on using a tennis ball as a massage tool:
http://www.simplebackpainrelief.com/sciatica/how-to-massage-gluteal-muscles-for-back-pain-relief/
And here’s an article about muscles near your waist that can also cause sciatica.
http://www.simplebackpainrelief.com/sciatica/which-muscles-in-your-lower-back-can-cause-sciatic-pain/
But I’m kind of leaning toward the tight gluteals because of your feet symptoms. That’s where I would suggest starting. And it is possible that if you have flat feet they are causing you to have tight gluteal muscles. You may need arch supports but maybe the ones you had (or the shoes you wore them in) weren’t quite right for you.
Let me know your progress after you ‘massage’ and relax your buttock muscles. You may find quite a bit of tenderness there initially. Let’s see if that’s the key to getting rid of the pain in your feet.
Kathryn
The Pain Relief Coach
i for six months iv had pain in my knee wen i climb stairs and swelling on top of my foot at end of most days i get sharp pains and there id numbness im having an ultrasound next week coud this be tarsal tunnel
Hi Julie,
It’s good you are having the ultrasound. It may possibly be a cyst on the top of your foot causing your symptoms. But remember, I’m not a doctor and this isn’t a diagnosis–it’s my long distance thought.
Your knee pain may be caused by muscles that are tight in your leg or maybe from the way you are using your foot. Knee pain can also be caused by ligaments or other parts inside the knee. Your doctor can make this determination.
Therapeutic massage is the most non-invasive way to try to get rid of foot and knee pain. If the tests find nothing, that is a good sign that muscles are the cause.
I hope this helps you feel a bit better. Please let me know if you have more questions after you get the ultrasound results.
Kathryn
The Pain Relief Coach
hi there.
i have been struggling with foot pain in both feet for about 5 years now– misdiagnosed as plantar fascitis for a long time (super rigid plastic custom orthotics that were even more painful, wore EVERY TYPE OF SHOE), and i have seen 2 podiatrists (complete idiots in my opinion who didn’t ever make the connection to tarsal tunnel) 1 rhumitologist (to rule out arthritis, etc), 1 physiologist, 2 physical therapists (1 post surgery, 1 pre surgery for 6 months who didn’t do anything helpful) and now my orthopedic surgeon. just a year ago i had the nerve conduction test which showed tarsal tunnel.
i had the surgery dec 19th , as well as an ankle reconstruction because of previous sprain and frequent “rolling”, and i have had no improvements to my symptoms dealing with foot pain, but i am positive i have tarsal tunnel because my doctor said my the muscle was super tight and my symptoms are exactly as listed (the “feeling like the foot doesn’t have enough cushion” is usually my biggest one, along with the bottoms of my feet always asleep and sharp heel/ball of foot pain)
now it is 2.5 months later and i am left wondering when will it ever get better! will it even? i am only 20 and this is ruining my life. what is the longest time you have heard for the surgery to take to “kick in”? i am so envious of those who say after 2 weeks it was better. i guess my real question is, after how long should i know that the surgery definitely didn’t work. any help would be appreciated.
thank you so much.
Hi Elizabeth,
I’m leaning toward thinking your foot pain was or is caused muscles but remember this is my best long distance thought and I’m not a doctor.
Lots of folks don’t have much foot padding. I can always tell the ones who love to walk barefoot because they have thick well-cushioned soles.
Start massaging, rubbing and pressing on the muscles of your feet and lower legs. If you can, go to a professional massage therapist who can work deeply on those muscles (after warming them up.) Massage works better than stretching or any other therapy and is the first step in normalizing muscles so strengthening therapies can work.
If you can, have someone assess your posture or look sideways in a mirror. How is your posture? Do you look like you are downhill skiing? Is your upper back rounded forward?
Arch supports can be hard to adjust to when muscles are tight. Rolling feet on a tennis ball (or similar ball) while applying pressure can help foot muscles relax.
Do you have flat feet? This can throw your posture off and cause foot pain, leg pain and even pain in the neck!
It can take time for the swelling from surgery to go down enough so that the pain goes away. That’s usually 6 weeks or so. Have you asked your doctor when it will feel better? Have you asked him why it doesn’t yet?
Have you used cold therapy for your feet? That helps muscles relax and feel better. ( I am assuming you have no metal parts in your repaired ankle.)
I hope these long distance thoughts will help you, Elizabeth. The best I can think of right now is to get started with massage to correct your posture and work deeply into your leg and foot muscles. This just may be the ticket to help you get rid of your foot pain naturally.
Kathryn
The Pain Relief Coach
Hi
Im not sure if I have tarsal tunnel syndrome or not. I have a bit of pain most days in my foot but its more uncomfortable than anything else. However sometimes the pain is unbearable and I cannot stand anything to touch my foot. My foot also swells up and I cannot move my toes. Walking is impossible as I cannot put any weight on my foot. Obviously you cannot diagnose me I just wondered if you could tell me if the symptoms sound like tarsal tunnel syndrome.
Thank you
Hi Alan,
My first thought is gout, based on your description. If it was TTS it would be more continuous but gout sometimes comes and goes. I hope this helps you narrow down possible causes for the pain in your foot.
Kathryn
The Pain Relief Coach
Hi,
Here is some info about my TTS. I once had plantar fasciitis caused by bad orthotic inserts, and that condition was insufficiently treated for long while. As a result, I spent nearly two years walking incorrectly and shifting my weight to the outside of my feet, in addition to the right leg overcompensating for an unrelated ankle problem on the left side. While working a piano pedal, I felt a stinging sensation on the inside of my right ankle which I now recognize as an electrical shock sensation. At first I thought something had stung me, but it went away after just a few seconds. However when I tried to get up I found my heel was in extreme pain. This was just over two years ago. After diagnosis, I had success with a prescription compound medication cream applied to the tarsal tunnel area. The heel pain gradually went away almost completely. While icing the tarsal tunnel area with an ice pack, the nerve was suddenly distressed again and immediately the terrible heel pain was back. A cortisone shot was administered but had no effect. Gradual help came again with the prescription compound cream. Since then I have not used ice to treat the condition, as it seems to have made it worse. Eventually all the heel pain went away, but for the past 8-9 months I have a painful sensation in the tarsal tunnel itself. The tunnel itself did not always hurt, but it began to after the heel pain was nearly gone. I would not describe it as burning or stinging, it is simply extreme irritation which feels like something is pressing on the nerve. The compound cream has had no effect, nor has various medication for nerve pain. It is further aggravated by a pedaling motion, such as working the gas/brakes of a vehicle, or playing pedals of instruments such as drums and piano. An immobility boot does offer minor relief when the discomfort flares up more than normal.
My question is whether or not surgery is something I ought to be looking into at this point. There was no injury relating to this condition, I believe the ankle joint had simply done too much overcompensating and incorrect walking. A cortisone shot was ineffective and ice was detrimental. I found a calf stretch online on a TTS website which is done 3x/day which does help some. The constant pressure on that nerve is unbearable, but reading your info here causes me to wonder if I should be focused on trigger points and seeking massage therapy, or whether the nature of my circumstances points to surgical relief. Just for background info purposes–I have never been overweight and prior to all this I routinely stretched and exercised and was very active. Also tests by a rheumatologist for an unrelated condition turned up no diseases. I am 33 and in good health in general. Any info as well as your opinion would be greatly appreciated.
Hi Landon,
You did a great job of explaining the pain around your tarsal tunnel area. Here are my thoughts:
1. You are very young and not overweight so you have a great chance of healing naturally. I have seen bodies heal over and over. Sometimes they just need a bit of help.
2. Some chiropractors (not all by a long shot) manipulate the bones of the feet to realign them. Sometimes a bone gets “out of place.” Sometimes that may happen from a posture or position or even from sleeping one time in an unusual position. Again, your age has benefit.
And muscles move bones so a skilled massage therapist (perhaps Rolfer or Neuromuscular massage therapist) might be able to get to the root of your foot pain so it won’t come back. Some massage therapists have learned how to distract the ankle bones. This is not a adjustment; it is stretching the soft tissues between the bones.
3. I am very much in favor of natural remedies being undertaken first. Surgery has permanent effects and may or may not work. Trigger point therapy could be just the ticket to help you get rid of this ankle joint pain. It won’t hurt to give it a good try.
You said there is no underlying disease. I believe that you are very uncomfortable. Nervy pain is extremely uncomfortable.
Perhaps it was not the cream so much that made the difference–perhaps it was the application of the cream. Could it have been the massage?
It’s interesting that ice didn’t help. Ice is the drug of choice for nervy pain. I wonder whether it was the position while the ice was being applied rather than the ice that caused the aggravation?
If it was my foot here is what I would do: Continue the stretching that helps. Seek out a real trigger point or structural alignment therapist. Do self massage and thoughtful movements. My very last choice would be surgery and I would grill the surgeon first about possible outcomes.
And, are you wearing good orthotics now? Are you sure they are not aggravating you? Do they support you well? Were you walking WAY over on the sides of your feet with the ‘bad’ orthotics? Why did you get them in the first place–flat feet or high arches?
I hope this helps you get rid of the pain in your tarsal tunnel area.
Kathryn
The Pain Relief Coach
Thank you, Kathryn.
I would like to respond to your questions, if only to make sure I’m conveying the full story as accurately as possible. I currently do not wear orthotics, and that is how my feet seem “happiest.” I have always been very active and without any foot problems. About 4 years ago the tendons in my left ankle suddenly became extremely inflamed. (It has remained a medical mystery to this day, but finally physical therapy is helping it to get better.) Several acquaintances suggest I try some high-end orthotics because they had used them successfully with foot and ankle problems. I thought it couldn’t hurt to have my foot better aligned, so I used the same reputable store they had, and purchased the orthotics. So I bought them not because flat feet or high/falling arches, but because I hoped they would assist recovery in my left ankle. Unfortunately, I developed plantar fasciitis immediately after using them, and upon the advice of an orthopedic doctor and a podiatrist, I stopped using them, as they told me orthotics can help people with foot problems, but for people with no natural problems like myself, they can be harmful as well. Anything that changes my natural step could be harmful, they said. So after finally getting rid of plantar fasciitis, I have no problems with my feet (other than the heel pain from TTS I developed), and the plantar fasciitis has not returned in the ~2 years since I got rid of it, and I notice that even much less aggressive orthotic inserts still make my feet ache and become uncomfortable. So my feet feel fine, like they’ve been most of my active life….with just them and my shoes. About the ice on the tarsal tunnel: I was sitting propped up on a couch with my legs outstretched, ice underneath/to the side of the ankle. I don’t know if that was a poor position or not, but it’s not an unusual one for me, similar to sitting in a recliner with the footstool out but only slightly reclined. About the compound cream: I applied it very gently, so I’m not sure how much its application could’ve been considered “massage.” On the same site I found the TTS stretching exercise I also learned an “up and down” massage technique for TTS which does not seem to help any. When I applied the cream my hand was moving with the tunnel, but as I mentioned, very gently, and only for long enough to rub the cream in.
I forgot to mention to you about barometric pressure. Anytime air pressure drops, such as when a weather-front is moving in or after a rainstorm, my TTS feels much better. The ankle feels almost completely normal until the air pressure levels off again. I used to check that sensation with weather.com to see what was happening with the air pressure, and it never failed. At this point I no longer need to check a website, I can tell if the nerve aggravation goes away that the air pressure is dropping.
I have read that scar tissue pressing on the nerve can be a common cause of TTS, and that surgery may be required to do something about that. However, it seems that scar tissue would form gradually, and I clearly recall sitting at the piano going from normal to “OUCH” immediately. I am a drummer and have years of working pedals on me, and am aware that such repetitive motions can cause scar tissue. However TTS has never bothered my left ankle, and I am also aware that TTS is not a common problem amongst drummers. So while scar tissue MIGHT be the problem, I am optimistic that it is not. Because it also seems like scar tissue presssing on the nerve would not be affected by air pressure, but my TTS very much is. That being the case, perhaps surgery could not fix whatever the true cause of my TTS is. But I don’t know….I am not educated enough to know what the surgery claims to correct and what it does not.
I have located a neuromuscular massage/trigger point therapist near me, and I am going to do what you recommend and at least give it a shot. I almost meant to ask you about acupuncture, and if you are familiar with it and if you felt like that might do any good. I have never had it and have read that there is very little medical evidence to support acupuncture, but I’m also aware that many people claimed it has helped them with various problems. I have tried electroshock therapy with a TENS unit on my TTS, which supposedly does much the same thing as acupuncture by getting more blood to flow to the area. However the TENS unit always irritated the TTS instead of helping.
Thanks again!
Hi Landon, You’re welcome. Thank you for the additional info about your tarsal tunnel pain. I’m going to paste your comment here and put my responses in italics between your words. I think that will be easiest to follow. ~ Kathryn Merrow, the Pain Relief Coach
Here’s your comment:
I would like to respond to your questions, if only to make sure I’m conveying the
full story as accurately as possible. I currently do not wear orthotics, and that
is how my feet seem “happiest.” I have always been very active and without any foot
problems. About 4 years ago the tendons in my left ankle suddenly became extremely
inflamed. (It has remained a medical mystery to this day, but finally physical
therapy is helping it to get better.)
“Medical mysteries” generally involve muscles and soft tissues. That’s just because most doctors don’t know much about them. And that makes me wonder if there are any physiatrists in your area? Those are physical medicine doctors(MD’s)and they DO look at the whole structure to figure out symptoms.
Several acquaintances suggest I try some
high-end orthotics because they had used them successfully with foot and ankle
problems. I thought it couldn’t hurt to have my foot better aligned, so I used the
same reputable store they had, and purchased the orthotics. So I bought them not
because flat feet or high/falling arches, but because I hoped they would assist
recovery in my left ankle. Unfortunately, I developed plantar fasciitis immediately
after using them, and upon the advice of an orthopedic doctor and a podiatrist, I
stopped using them, as they told me orthotics can help people with foot problems,
but for people with no natural problems like myself, they can be harmful as well.
Anything that changes my natural step could be harmful, they said. So after finally
getting rid of plantar fasciitis,
Interesting what the doctors said. Plantar fasciitis is most often caused by tight calf muscles.
I have no problems with my feet (other than the
heel pain from TTS I developed), and the plantar fasciitis has not returned in the
~2 years since I got rid of it, and I notice that even much less aggressive orthotic
inserts still make my feet ache and become uncomfortable.
Flat feet or feet that need orthotics have discomfort at first because the muscles and ligaments are not used to the correction. I’m just saying that and not directing it toward you.
So my feet feel fine,
like they’ve been most of my active life….with just them and my shoes. About the
ice on the tarsal tunnel: I was sitting propped up on a couch with my legs
outstretched, ice underneath/to the side of the ankle. I don’t know if that was a
poor position or not, but it’s not an unusual one for me, similar to sitting in a
recliner with the footstool out but only slightly reclined. About the compound
cream: I applied it very gently, so I’m not sure how much its application could’ve
been considered “massage.” On the same site I found the TTS stretching exercise I
also learned an “up and down” massage technique for TTS which does not seem to help
any. When I applied the cream my hand was moving with the tunnel, but as I
mentioned, very gently, and only for long enough to rub the cream in.
I forgot to mention to you about barometric pressure. Anytime air pressure drops,
such as when a weather-front is moving in or after a rainstorm, my TTS feels much
better. The ankle feels almost completely normal until the air pressure levels off
again. I used to check that sensation with weather.com to see what was happening
with the air pressure, and it never failed. At this point I no longer need to check
a website, I can tell if the nerve aggravation goes away that the air pressure is
dropping.
This is interesting! People with Fibromyalgia Syndrome can often tell the weather very accurately because their muscle pain level will go up or down. And I knew a man with cluster headaches who experienced the same phenomenon in his head (according to his doctor.)
I have read that scar tissue pressing on the nerve can be a common cause of TTS, and
that surgery may be required to do something about that. However, it seems that
scar tissue would form gradually, and I clearly recall sitting at the piano going
from normal to “OUCH” immediately.
That makes me think of dislocation and that’s why I suggested the possibility of a chiropractor in the last reply. SOME of them adjust feet and ankles.
I am a drummer and have years of working pedals
on me, and am aware that such repetitive motions can cause scar tissue. However TTS
has never bothered my left ankle, and I am also aware that TTS is not a common
problem amongst drummers. So while scar tissue MIGHT be the problem, I am
optimistic that it is not. Because it also seems like scar tissue presssing on the
nerve would not be affected by air pressure, but my TTS very much is. That being
the case, perhaps surgery could not fix whatever the true cause of my TTS is. But
I don’t know….I am not educated enough to know what the surgery claims to correct
and what it does not.
Ask a million questions. No sense having surgery that ‘might’ help (according to me.) 🙂
I have located a neuromuscular massage/trigger point therapist near me, and I am
going to do what you recommend and at least give it a shot.
Good! Give it a good shot, at least a few times. You may be able to tell some difference the first visit but give the person a chance. However, if he or she does general full-body type massage it won’t help. I would expect the therapist to work all around your lower leg and foot.
I almost meant to ask
you about acupuncture, and if you are familiar with it and if you felt like that
might do any good. I have never had it and have read that there is very little
medical evidence to support acupuncture, but I’m also aware that many people claimed
it has helped them with various problems.
If I had the choice between neuromuscular massage therapy and acupuncture, I’d go with the massage in a heartbeat.
I have tried electroshock therapy with a
TENS unit on my TTS, which supposedly does much the same thing as acupuncture by
getting more blood to flow to the area. However the TENS unit always irritated the
TTS instead of helping.
You definitely know that you are experiencing nerve sensations. Nerves can be entrapped by muscle or bones. Muscles move bones. When the muscles are released or relaxed, sometimes the bones will realign themselves with a little movement. I hope this helps you a little bit more with getting rid of your tarsal tunnel syndrome pain naturally.
Thanks again!