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Saturday, October 28, 2017

Possible Tarsal Tunnel Syndrome: Email Advice

Hi Dr Blake,

I hope you're well.  

I am wondering how to know if the pain in my foot/ankle/lower leg is coming from the FHL, FDL, or Tibialis Posterior? They all seem to have the same location and trigger points from the muscle are also close together. I would like to do self-massage to release whatever is trapped/tight if possible.
Dr Blake's comment: These are the 3 tendons that run together in the tarsal tunnel. 

Some history:

Two and half years ago, I injured my FHL tendon where it meets my sesamoid (imaging showed inflammation and swelling at 1st metatarsal, fracture of sesamoids ruled out) on my right foot.  I developed nerve pain as a result (in right foot and leg, and mirror nerve pain in left foot and leg), as well as piriformis syndrome in my right glute from the gait changes.  Tendon eventually healed, but different kinds of nerve pain/patterns and piriformis muscle pain remained, sometimes mild sometimes more severe.  Additional imaging ruled out lower back/SIJ issues.  

Two months ago, I developed an intense tension in my right foot, very close to my Achilles tendon, between my Achilles tendon and ankle bone on the inside of the leg, when walking.  Tension would feel like somebody was pulling my heel back whenever I tried to take a step forward, as if one of the tendons/ligaments was too short and bouncing back each time.  Pain could not be reproduced on pressing the area of the pain, just when stepping forward. Pain only appeared when I put on my shoes and took a step, when at home in flip-flops I could walk pain free. The pain came and went for about 10 days, then disappeared.  
Dr Blake's comment: This is classic tarsal tunnel (nerve) symptomatology, not tendon. 

A week ago I started feeling pain in my right foot, starting from the bottom just in front of the heel (between heel and arch) and shooting upwards towards the back of my ankle bone on the inside of my leg.  Not a nerve pain feeling, but a tension again, less severe than two months ago, different spot (but nearby), and sometimes starts tingling sligthly when I press on it.
Dr Blake's comment: It is called neural tension, and definitely neurological. 

 Tried rolling foot on tennis ball at point of pain and felt tingling on bottom of foot towards big toe (similar to pain from FHL injury 2.5 years ago but much less intense). Did not continue rolling on ball.  Being familiar with trigger points, I press my lower leg up from ankle (on inside of leg) to calf and get some referred pain into my foot between the heel and arch.  Pain is felt when swimming, walking, and stretching body when waking up (tension/soreness) and when not moving (dull throbbing ache).
Dr Blake's comment: It is half neurological, and half tendon, the way you describe. When the 3 tendons are individually stressed, how do you feel? Rich 

Any ideas of which tendon this could be and suggestions of how to release whatever is pulling on the tendon would be much appreciated! I would rather not go to doctors and physiotherapists all over again, but would not want to leave this if it might get worse.  I got used to the residual/chronic nerve pain and piriformis muscle pain but would not want to start shifting gait again.
Dr Blake's comment: If you were in my office, and I tested the 3 tendons without problem, I would put you on a tarsal tunnel protocol of neuro flossing, neurological-eze gel top massage, no stretching, active ankle range of motion, warm soaks 20 minutes twice daily, orthotics or sole wedges if you pronate, and consider lyrica  for evening at least. Rich

Thank you,

1 comment:

  1. Thank you! The pain has now moved up to the back of my calf, in the centre, about five finger widths above the ankle bone. I get significant relief from massaging that spot sideways (not up and down). I will visit a doctor to get each of the three tendons tested as I do not know how to test them myself. Thanks


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.