Nerve compression can be caused by swelling from an injury, anatomical variations or changes in foot structure, tumors or even by movement or biomechanical errors in the foot, among other things. All the nerves in your foot originate at the spinal cord and travel through the leg down to the foot as peripheral nerves. These nerves bisect and split at various points and carry both sensation and motor commands to the skin, joints and muscles. Because nerves travel long distances to reach the foot, symptoms of a pinched nerve in the foot can originate from much higher up in the leg.

Several common nerve compression conditions cause symptoms in the foot. One important goal of your physical therapy evaluation is determining where your symptoms originate including ruling out radiating symptoms from the spine. Below are descriptions of some conditions involving pinched nerves in the foot.

TARSAL TUNNEL SYNDROME

Tarsal Tunnel Syndrome refers to compression of the posterior tibial nerve as it runs through a space called the tarsal tunnel on the inside of the ankle. Quite a few important structures run through the tarsal tunnel including:

• Tibialis posterior tendon
• Flexor digitorum longus tendon
• Posterior tibial artery & vein
• Tibial nerve
• Flexor hallucis longus tendon

ANTERIOR TARSAL TUNNEL SYNDROME

Compression of the deep peroneal nerve is rare but is commonly referred to as anterior tarsal tunnel syndrome. Weakness in the foot and toes and pain or sensory changes in the foot near the webspace of the first and second toes are also characteristic of compression of this nerve. Causes of this nerve compression range from space occupying lesion such as a ganglion cyst, osteophytes on the bone or hypertrophy of overlying muscles to extrinsic causes such as a tight-fitting shoe, a traction injury from an ankle sprain and even repetitive ankle plantarflexion such as during dancing or soccer.

SINUS TARSI SYNDROME: The sinus tarsi is located on the outside aspect of the foot in front of the ankle. When swelling, irritation or compression of the sinus tarsi occurs, the nerves that travel through there can be pinched causing burning, numbness or tingling radiating out from that area.

MORTON’S NEUROMA: A morton’s neuroma is a bit different than the other nerve compression conditions discussed above. However, since this condition can feel similar to nerve compression it is worth mentioning. Morton’s neuroma is inflammation of one of the nerves of the foot between the long bones, behind the toes. People with Morton’s neuroma often feel like they are standing on a marble. Pain is the most common symptom but numbness and tingling in the area can also occur.

PLANTAR NERVE ENTRAPMENT: Caused by compression or entrapment of the plantar nerve, this condition can sometimes be confused with plantar fasciitis. Unlike plantar fasciitis which improves with rest and is usually the worst when you first put pressure on the foot in the morning, plantar nerve entrapment causes a burning heel pain that persists even at rest. It is often worse at night and can increase with stretching or standing activities.

If you decide to work with a physical therapist to help correct your pinched nerve in foot, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

DIAGNOSIS AND TREATMENT OF FOOT NERVE COMPRESSION

Diagnosis of nerve compressions in the foot is often based on clinical signs and symptoms as well as provocative tests such as the Tinel’s sign wherein the therapist taps on the involved nerve over the compressed area and it reproduces your primary symptoms. EMG studies, X-rays, ultrasound, CT scans or MRIs can also be used to look for abnormalities in bone structure, signs of inflammation or space-occupying lesions.

If you have nerve compression or a Morton’s neuroma, a conservative approach is usually recommended first. Your physician may prescribe a course of nonsteroidal anti-inflammatory or pain medications or a corticosteroid injection to manage pain and inflammation. Your physical therapist will then work to reduce compression, improve foot and ankle biomechanics and so forth to reduce your symptoms. In the case where conservative therapy does not fully address the nerve compression, surgery may be recommended by your doctor to relieve the remaining compression on the nerve.

WHAT PHYSICAL THERAPY TREATMENTS ARE BEST FOR A PINCHED FOOT NERVE?

While physical therapy for these conditions will always be individualized to your specific needs, below are some common goals and treatments of physical therapy to manage nerve compression in the foot:

TREATMENT TO REDUCE INFLAMMATION: modalities like ice, ultrasound, contrast baths or iontophoresis may be used to reduce inflammation or swelling around a nerve or injured tissue

NERVE AND TISSUE MOBILITY EXERCISES: nerve mobilization and soft tissue mobilization techniques are often used to reduce nerve compression, improve blood flow and nerve mobility

ORTHOTICS, FOOTWEAR AND TAPING: foot orthotics, heel wedges, footwear and lacing modifications and taping may be used to improve foot biomechanics and reduce compression during standing and walking

STRETCHING: Calf and other muscle stretching is often prescribed to improve muscle length

STRENGTHENING AND MOTOR CONTROL: Muscle strengthening of leg foot and ankle muscles, is often prescribed to help improve mechanics and control of the foot as are exercises to improve control of the foot

Symptoms of nerve compression in the foot can be uncomfortable and impact your ability to stand and walk. It is important to locate the cause of your symptoms before treating it. If you think you may have a pinched nerve in your foot, call Evolve Physical Therapy today to schedule an initial evaluation and let our team of therapists guide your recovery.