Stop Tarsal Tunnel Syndrome Pain Naturally: Symptoms, Causes, Healing Cycle & Treatment

What is tarsal tunnel syndrome pain?  

Tarsal tunnel syndrome is characterized by entrapment of the tibial nerve. This entrapment neuropathy is also known as posterior tibial nerve neuralgia and tibial nerve dysfunction. This condition is similar to wrist carpal tunnel syndrome, however, it is relatively less prevalent. Structures present in the tarsal tunnel, which is a narrow space posteroinferior to the medial malleolus, include flexor digitorum longus, flexor hallucis longus, and posterior tibialis muscle tendons. Other important structures in this fibro-osseous space include the posterior tibial artery, posterior tibial vein, and posterior tibial nerve (L4-S3). While the incidence and prevalence of tarsal tunnel syndrome are not definite, this pathology is relatively higher among females compared to males of any given age. [1] The following sections describe the causes, risk factors, normal healing cycle, healing cycle in chronic conditions, ineffective treatments, and effective treatments of tarsal tunnel syndrome pain. 

Causes of Tarsal Tunnel Syndrome  

The causes of tarsal tunnel syndrome are classified into intrinsic and extrinsic etiological factors, which are enlisted as follows. The mechanism of tarsal nerve impingement can be observed in approximately 80% of tarsal tunnel syndrome cases. [1] Other causes of tarsal tunnel syndrome and associated pain include compression of the posterior tibial nerve, ankle sprain, excessive pronation of the foot, arthritis, and gout. 

Intrinsic causes of tarsal tunnel syndrome	Extrinsic causes of tarsal tunnel syndrome
Tendinopathy Tenosynovitis  Space-occupying lesions  Mass-effect lesions (enlarged veins, varicose veins, lipoma, neuroma, ganglion cyst, or neoplasm) Perineural fibrosis  Arterial insufficiency and nerve ischemia  Hypertrophic retinaculum Osteophytes	Poorly fitting shoes  Generalized lower extremity edema Diabete Post-surgical scarring  Trauma  Systemic inflammatory arthropathies  Systemic diseases  Anatomic and biomechanical abnormalities (valgus hindfoot, varus hindfoot, or tarsal coalition)

Symptoms of Tarsal Tunnel Syndrome 

Patients suffering from tarsal tunnel syndrome may present with the following symptoms. [1]

1. Radiation of pain along the posterior tibial nerve distribution 
2. Paresthesia along the posterior tibial nerve distribution 
3. Direct pain over the tarsal tunnel radiating to the plantar foot and the arch 
4. Numbness present over the plantar surface of the foot 
5. Onset of pain at the extremes of eversion and dorsiflexion 
6. Burning or tingling sensation 
7. Sharp shooting pain in the affected foot 

The symptoms of tarsal tunnel syndrome including pain may worsen during the night, after physical activity, and when the patient is standing and walking. The pain gets better when the patient is resting. [1] 

Ciclo di guarigione normale 

Before discussing ineffective and effective treatments for tarsal tunnel syndrome pain, it is important to have a basic understanding of how the normal healing cycle works. The main phases of the healing cycle are the inflammatory phase, the proliferative phase, and the maturation phase. [2] The details of each step are described in the given table. 

Fase infiammatoria	Proliferative stage	Maturation stage
The inflammatory phase is the initial phase of the healing cycle. The main signs of inflammation are pain, loss of function, swelling, redness, and warmth. This phase of the healing cycle is characterized by the recruitment of inflammatory and immune cells associated with the release of cytokines and inflammatory mediators. After the inflammatory phase subsides and the harmful substances are eliminated, the healing cycle moves to the next phase, namely the proliferation phase.	The second phase of the healing cycle is the proliferation phase. This phase is characterized by new blood vessel formation, extracellular matrix formation, collagen deposition, and re-epithelialization of the wound site. Negative feedback mechanisms are responsible for the regulation of the proliferative phase of the healing cycle. It suppresses excessive scar tissue formation and collagen deposition by proliferating fibroblasts.	The maturation phase of the healing cycle is the final phase and marks the resolution of the healing cycle. Wound contraction and scarring occur during this phase. Type III collagen is replaced by type I collagen in scar tissue. In chronic disease, the healing cycle does not progress to maturation. Instead, the healing cycle oscillates between inflammatory and proliferative phases. The persistence of these phases contributes to the formation of excess scar tissue, fascial restrictions, and muscle trigger points. They not only limit movement but also cause pain.

Ineffective Treatment for Tarsal Tunnel Syndrome Pain

1. Massoterapia
2. Massage therapy using a foam roller
3. Applicazione della terapia del calore e del ghiaccio
4. Electrical stimulation of the foot 
5. Mobilization of the foot 
6. Stretching of the foot 
7. Strength exercises during the inflammation stage of the healing cycle 

Effective ASTR-Based Treatment 

The following table comprises effective treatment measures for the alleviation of tarsal tunnel syndrome pain while resolving the inflammation and proliferation stages of the healing cycle and attaining maturation of the wound. 

Inflammation stage resolution	Proliferation stage resolution	Other therapeutic strategies
Adequate rest of the foot for resolving the inflammatory stage of the wound healing cycle MagnaHeal devices including MagnaHeal 1, MagnaHeal 2, and MagnaHeal Pro Anti-inflammatory supplements counter the nutrient deficiencies in the body and promote the alleviation of tarsal tunnel syndrome pain The consumption of an anti-inflammatory diet prevents chronic inflammation and accelerates recovery	A1 Tool releases superficial and deep fascia restrictions A3 Tool releases superficial scar tissue and superficial muscle trigger points A5 releases deep scar tissue, deeper muscle trigger points, and fascia restrictions of the endomysium, epimysium, and perimysium.	Patients of tarsal tunnel syndrome shall be encouraged to walk with a normal gait Affected individuals should wear good shoes  Tarsal tunnel syndrome patients shall ensure correct pronation of the foot

Conclusione 

Tarsal tunnel syndrome pain arises due to nerve entrapment and damage to other tissues present in the tarsal tunnel including nerves, blood vessels, and ligaments of specific muscles. Tarsal tunnel syndrome may hinder the performance of daily activities as well as influence the physical and social functioning of the affected individuals. ASTR-based treatment is a comprehensive approach to the recovery of tarsal tunnel syndrome and associated pain. It comprises A1, A3, and A5 for releasing scar tissue, fascia restrictions, and muscle trigger points. ASTR also offers a MagnaHeal device and anti-inflammatory supplements that strengthen the inherent ability of the human body to combat inflammation. 

Riferimenti 

1. Kiel J, Kaiser K. Tarsal Tunnel Syndrome. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK513273/
2. Grubbs H, Manna B. Wound Physiology. [Updated 2022 May 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK518964/