Anterior Tarsal Tunnel Syndrome

What is an Anterior Tarsal Tunnel Syndrome

Anterior tarsal tunnel syndrome is a condition that happens when pressure is put on a nerve that passes through the front of your ankle.

This nerve supplies the muscles that you use to move your foot and toes up toward your shin. It also supplies the skin between your big toe and second toe.

What are the causes?

This condition may be caused by:

• Pressure on the nerve, such as from footwear that is too tight or from a bony growth.
• Having an unstable ankle.
• Swelling in the front of your ankle.

What increases the risk?

This condition is more likely to develop in people who participate in sports that:

• Involve repeatedly using the front of the ankle to hit something, such as soccer and martial arts.
• Involve wearing a tight boot or skate, such as skiing or hockey.
• Can easily lead to a sprained ankle.

What are the signs or symptoms?

Symptoms of this condition can start quickly or develop gradually. Symptoms include:

• Pain or aching in the top of the foot.
• Numbness or tingling between the big and second toe.
• Difficulty bringing the toes upward.
• Pain when pointing the foot down.

At first, symptoms may be relieved with rest. Over time, symptoms may be present all the time.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
• Tests, such as:
  • An X-ray to check your bones.
  • MRI to check your nerves and tendons.
  • An electromyogram (EMG) to check your nerves.

During the physical exam, your health care provider may tap on the area below your ankle to check for tingling in your foot or toes. Your health care provider may also inject a numbing medicine at the top of your ankle to see if it relieves your pain.

How is this treated?

Treatment for this condition may involve:

• Adding padding to the front of your shoe, skate, or boot to reduce pressure on your nerve.
• Using ice to reduce swelling.
• Taking anti-inflammatory pain medicine.
• Having medicine injected into your ankle joint to reduce pain and swelling.
• Doing exercises when pain and swelling improve.
• Gradually returning to full activity.
• Having surgery. Surgery may be needed if there is a bone growth or if other treatments have not helped.

Follow these instructions at home:

Managing pain, stiffness, and swelling

• If directed, put ice on the injured area:
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.
• Take over-the-counter and prescription medicines only as told by your health care provider.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do notplace your full body weight on your ankle until your health care provider says that you can.
• Do notdo any activities that make pain or swelling worse.
• Do exercises as told by your health care provider.

General instructions

• Add padding to your footwear as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Avoid athletic activities that cause ankle pain or swelling.
• Do notlace your shoes or boots too tight.
• When you play contact sports, wear protective equipment over the front of your ankle.
• Do notput your feet under a solid object like a bar while doing sit ups.
• If you start any new athletic activity, start gradually to build up your strength and flexibility.

Contact a health care provider if:

• Your foot or ankle pain is not getting better after 2–4 weeks of treatment.
• You are unable to support (bear) your body weight on your ankle without feeling pain.

Anterior Tarsal Tunnel Syndrome Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse.  Do notbegin these exercises until told by your health care provider.

Strengthening exercises

These exercises build strength and endurance in your ankle. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise A: Eversion

1. Sit on the floor with your legs straight out in front of you.
2. Loop a rubber exercise band around your left / right foot around the ball of your foot. The ball of your foot is on the walking surface, right under your toes. Hold the ends of the band in your hands, or secure the band to a stable object.
3. Slowly push your foot outward, away from your other leg.
4. Hold this position for __________ seconds.
5. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Heel walking (

dorsiflexion) Walk on your heels for __________. Keep your toes as high as possible.

Repeat __________ times. Complete this exercise __________ times a day.

Balance exercises

These exercises improve or maintain your balance. Balance is important in improving ankle stability and preventing falls.

Exercise C: Tandem walking

Do this exercise in a hallway or room that is at least 10 ft. (3 m) long.

1. Stand with one foot directly in front of the other. You can use the walls to help you balance if needed, but try not to use them for support
2. Slowly lift your back foot and place it directly in front of your other foot.
3. Continue to walk in this heel-to-toe way for __________. Keep your balance without holding on to something for support.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Single leg stand

1. Without shoes, stand near a railing or in a doorway. You may hold onto the railing or door frame as needed.
2. Stand on your left / right foot. Keep your big toe down on the floor, and try to keep your arch lifted. If this is too easy, try one of these options during the exercise:
   • Stand with your eyes closed.
   • Stand on a pillow.
   • Throw a ball against a wall.
3. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Inversion/eversion 1

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles, tip the board from side to side as far as you can, alternating between tipping to the left and to the right. If you can, tip the board so it silently taps the floor. Do notlet the board forcefully hit the floor.

Repeat __________ times, pausing from time to time to hold a steady position. Complete this exercise __________ times a day.

Exercise F: Inversion/eversion 2

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles, tip the board from side to side, alternating between tipping to the left and to the right. Do notlet the board hit the floor at all.

Repeat __________ times, pausing from time to time to hold a steady position. Complete this exercise __________ times a day.

Exercise G: Plantar flexion/dorsiflexion 1

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles, tip the board forward and backward so the board silently taps the floor. Do notlet the board forcefully hit the floor.

Repeat __________ times, pausing from time to time to hold a steady position. Complete this exercise __________ times a day.

Exercise H: Plantar flexion/dorsiflexion 2

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles, tip the board forward and backward. Do notlet the board hit the floor at all.

Repeat __________ times, pausing from time to time to hold a steady position. Complete this exercise __________ times a day.