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Title: Early Effects of Foot Therapy and Correction of Foot Posture for Tarsal Tunnel Syndrome.
PNS ID: 111123-1, Published: 11/23/2011, Updated: 12/12/2011.
Author(s): Lawrence Zieske BA, Andrew Yee BS, Susan E. Mackinnon MD.
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.
Abstract: This 48-year-old woman presented with a three- to four-year history of severe bilateral foot pain that was worse on her left compared to the right side. On examination, the patient had flattened arches and a positive scratch collapse test over the tarsal tunnel on both feet. No Tinel’s sign was present over the tarsal tunnel. Electrodiagnostic studies were suggestive of mild tarsal tunnel syndrome. Foot physical therapy was issued to treat this patient's symptoms of tarsal tunnel syndrome. This therapy emphasized correcting the positioning of the foot to relieve compression of the tibial nerve through the tarsal tunnel. Exercises included flexion of the foot intrinsic muscles, foot balance, and standing heel raises. After two months of therapy, this patient showed improvement in her symptoms with greater relief of pain on the left compared to the right side. The scratch collapse at the tarsal tunnel was negative on the left, however it was still positive on the right. The patient continues foot physical therapy for improvement of foot posture. This early report describes the use of foot physical therapy to improve the positioning of the foot for relief of symptoms from tarsal tunnel.

Figures and Videos

Video 1 – Post-foot Physical Therapy Scratch Collapse Test at the Tarsal Tunnel and Foot Physical Therapy Exercises.   This patient presented with a three- to four-year history of severe bilateral foot pain, worse on the left compared to the right side. This examination took place two months following foot physical therapy, which focused primarily on the left foot. Pre-therapy, the scratch collapse test was positive bilaterally at the tarsal tunnel. Post-therapy, the scratch collapse test was negative on the left, however was positive on the right. Further into the video, the patient demonstrated several foot therapy exercises to strengthen intrinsic foot muscles and improve foot position. This resulted in the reduction of foot pain. These exercises included flexion of toes and soles of feet, foot balance, standing heel raises, and foot flexion against resistance.