Assess & Address: Tarsal Tunnel Syndrome by Whitney Lowe

Anatomical background Pathology Assessment & Evaluation Treatment Massage Techniques

Massage techniques
Soft-tissue manipulation

Massage may be helpful for nerve pathologies such as TTS, but must be done in a proper manner. If not, aggravation of the client’s condition may result. Because this condition involves nerve compression, the practitioner should not use any direct-compression techniques that further compress the nerve within the tunnel.

The primary purpose of massage for this condition is to indirectly affect the involved structures. That means techniques are aimed at reducing the factors that lead to TTS, but do not attempt to do anything specifically to the damaged nerve.

Tenosynovitis in the tibialis posterior, flexor digitorum longus and flexor hallucis longus may be compressing the nerve. Deep longitudinal-stripping methods for these muscles help reduce accumulated tension and may decrease the inflammatory reaction of tenosynovitis (Figure 8). These massage treatments are likely to be particularly beneficial when done in combination with biomechanical corrections, such as orthotics.

Longitudinal-stripping techniques may be performed passively, but are particularly effective when combined with active engagement. In this method the stripping technique is performed along the medial tibial border at the same time the client is dorsiflexing the foot (Figure 9). Performing this stroke as the client is elongating the affected muscles produces a more effective penetration of the pressure. (This technique is particularly helpful in the posterior tibial region because the muscles are difficult to access due to their depth and the overlying soleus and gastrocnemius.) These deep longitudinal-stripping techniques should also be performed on the plantar surface of the foot to reduce tension in any of the affected intrinsic foot muscles, as well as to enhance mobility of the distal branches of the tibial nerve.

Conclusion

While TTS is not a common pathology, it is one the massage practitioner should be aware of. Several important biomechanical factors need to be analyzed to properly identify this condition. Pain on the bottom surface of the foot is commonly ascribed to other conditions, such as plantar fasciitis. If the pain has strong neurological symptoms, it may often be perceived as a nerve-root pathology affecting the L5 or S1 nerve roots. Because there are a number of conditions that may produce identical symptoms, it is important to take the time and effort to explore the condition in detail to properly identify its nature and the tissues involved. This way the practitioner is in a better position to choose the most beneficial treatment approaches using massage.

References