Plantarfasciitis and Tarsal tunnel syndrome - why do we need to differentiate? From an Orthotist's perspective.
Normal foot orthotics, indicated to relieve Plantarfasciitis, in almost 50% of the cases that I have treated, foot orthotics aggravates the symptoms. Compression, by a traditional foot orthotic, on the posterior tibial nerve (PTM) can worsen or prolong the pain. At Shore Orthotics we make special adaptations to ensure the posterior tibial nerve is protected. The PTM relief fabrication method can be either in the soft or the semi rigid foot orthoses. Differentiating can help patients who haven't had relief from traditional orthotics or who are still experience reoccurring pain and agony. What does it matter? How can we make sure that we apply the right kind of orthosis? A high percentage of Plantarfasciitis patience suffer from a combination of symptoms associated with Plantarfasciitis and Tarsal tunnel syndrome.
Two different names; one patient scenario?
Plantarfasciitis and Tarsal tunnel syndrome are well documented, however what is not commonly documented is how often these conditions coincide in the same complaint of pain in the foot. It could be argued that this posterior medial nerve impingement syndrome is not classic Tarsal Tunnel syndrome as it usually appears distal to the Tarsal Tunnel, but before the tibial nerve branches.
My experience of making foot orthotics for patients with Plantarfasciitis, with many not getting the desired relief, led me into a lengthy search for an answer. I came to the understanding that compression of the posterior tibial nerve in the orthosis may well have been part of the problem and therefore should be part of the solution. We recently ran an in-house study to get clearer, evidence based results on the observations and it appeared that 50% of patients were suffering from a combination of symptoms of both pathologies.
The question needs to be asked, whether they had both pathologies from the beginning or it developed with the continued pressure of the orthosis on the posterior tibial nerve is not known. Once the pressure on the PTN was relieved the on-going irritation was gone and the patient was pain free.
How is the compression of the posterior tibial nerve identified and separated from the symptoms of Plantarfasciitis?
The key lies with the type of pain:
- Burning pain mostly constant
- Early morning pain after the first step
Posterior tibia nerve compression:
- Shooting pain often towards the toe along the posterior aspect of the heel down the lateral border of the foot.
Shore Orthotics test is to palpate the foot and press on the posterior distal aspect of the calcaneus where the posterior tibial nerve runs.
This will reproduce the pain is the PTN is involved. A positive test indicates that the Tarsal Tunnel relief needs to be incorporated into the design of the orthoses. This can be achieved in both the Soft Custom and the Semi Rigid orthotic versions. The PTN Orthosis will be documented on this site shortly.