Anterior tarsal tunnel syndrome

This condition is caused by a compression of the deep peroneal nerve as it passes beneath the superficial fascia at the front of the ankle joint. According to the Injury classification system, this syndrome, usually develops because of a misalignment issue at the ankle joint (Tibia-Talus) considering a level 1 injury with associated nerve entrapment. Chronic injuries at the ankle may also narrow the nerve passage due to the scar/fibrotic tissue at the superficial fascia and by the osteophytic bone formation from the underlying bones. This condition may cause significant deep aching pain with associated numbness and pins and needles at the dorsum of the foot particularly when plantar flexing the foot and wearing tight shoes.

Mechanism of Dysfunction

The main predisposing factor for the development of this condition is a dysfunction at either the tibia or the talus misaligning forward and irritating the peroneal nerve.

Assessment Protocol

The entire lower extremity biomechanical chain must be evaluated as part of the foot/Toe analyses as per the neurological and mechanical influences of the spine, hip, and knee. Lower Disc lesions and Proximal Fibula dysfunction may be ruled out.

Clinical assessment of the Tibia – Talus joint identifying the primary misalignment pattern.

Tinel Neurological sign

X-ray analysis.

Depending on the level of arch compromised, X-rays may be indicated to allow proper alignment analysis of the key joints.

Lateral Xray view is essential to check the primary bone misalignment that is responsible for the direct nerve irritation, either the tibia or talus.

Anterior – Posterior (AP) X-ray ankle view is essential for identifying the further misaligned patterns of the talus bone.

MRI analysis

Important exam to verify the level of narrowing of the nerve passage and the degree of nerve inflammation.

Treatment protocol

There are two direct important misalignments that needs to be addressed to aid on the reduction of nerve pressure.

Tibia posterior adjustment or Talus adjustment

Neuromobilization techniques may be used once the direct compression of the nerve is reduced.

Specific therapeutic essential oils is applied to reduce never inflammation and enhance healing.

Depending on the level of nerve compromised and chronicity of the misalignment a minimum of 6 weeks up to 12 weeks of treatment care may be necessary to resolve this deformity.