Sciatica VS. Tarsal Tunnel Syndrome
Tabassum Ali, DC, CCSP, CCCN
Numbness found on the bottom of the foot is a common symptom found in runners and corporate workers alike. The cause of foot numbness can stem from many different sources.
Foot swelling from running
Posterior tibial tendon dysfunction
Posterior Compartment Syndrome
The first thought process when a runner complains of foot numbness while running can be due to swelling of the feet while running, and if the shoe laces are too tight it can compress the vasculature leading to numbness of the foot. An acute injury, such as from a fall, can tear the posterior tibial tendon or cause it to become inflamed. The tendon can also tear due to overuse. For example, people who do high-impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive use. Once the tendon becomes inflamed or torn, the arch will collapse over time. Posterior tibial tendon dysfunction, tarsal tunnel syndrome, is more common in women and in people older than 40 years of age. Additional risk factors include obesity, diabetes, and hypertension. High-impact sports can also put a lot of pressure on vertebral discs and cause a herniation or rupture. If you have a herniation or rupture of the vertebral disc, symptoms of pain and numbness that trail along the lower extremity into the foot are common. Fibromyalgia syndrome is another cause of foot numbness. Typically found in females age 20-50 with long-term tenderness and pain in the joints and muscles. Multiple Sclerosis is an autoimmune condition that can affect women between 20-40 years of age and lead to damage of the myelin sheath of nerves, causing symptoms of muscle spasms and numbness. Diabetes is a metabolic disease found in those with elevated blood sugar levels and low blood circulation, which leads to nerve damage and eventually numbness in the hands and feet.
Vasculature in the lower extremity is intense and heavily intertwined. A general understanding of anatomy is important to diagnose the cause of the foot numbness. In an ankle joint with swelling or prior traume, the vasculature and nerves can become quiet irritated and become inflamed. Those who have difficulty running may have a restricted joint in the lower extremity, but a majority is due to poor biomechanics from a previous overuse injury of the soft tissue.
When observing the ankle for motion, the patient may experience numbness with flexion and extension, which is a good indicator that there is some sort of restriction in the soft tissue or in the joint. To fully diagnose a foot numbness, a thorough functional assessment and foot and ankle exam must be done and in some cases imaging may be necessary. A musculoskeletal ultrasound would be ideal to view an possible damage to the underlying soft tissue of the foot and ankle. The choice of imaging for a disc is, MRI. For palpation, the examiner should use the plantar surface of the fingers and palpate along the medial malleous, looking for possible tenderness and numbness from compression may be noted. Valgus and varus stress may be put on the joint to rule out any ligamentous injuries, and traction of the mortise joint. Possible treatments for foot numbness:
Addressing the scar tissue formation
Eccentric rehabilitative strengthening exercises
RICE (rest, ice, compress, elevate)
Orthotics (once fully examined by an Podiatrist)
Surgery based on the severity of the dis herniation/rupture
Refer out to metabolic or internal specialist
Addressing the scar tissue and rehabilitation of the ankle is very important. Skipping out on stretching can lead to further advanced conditions. A misconception that many runners have is, a tight muscle indicates a strong muscle- this is incorrect! Although a tight muscle can be strong, it is more common that the muscle is weak and spasming in hopes of remaining stable, but probably on the verge of an injury. Warm up of the ankle joint and calves are important before beginning any strengthening protocol. An example of an ankle and calf stretch would be downward facing dog yoga pose. Eccentric and proprioceptive exercises to strengthen the muscles of the lower leg and ankle are highly suggested. Approximately 6-8 weeks of treatment will be needed, depending on the severity of the injury, to decrease the pain and strengthen the muscles.
At Lone Star Sport & Spine, we approach injuries in a conservative manner that will give the patient the most weighted benefits. Our providers are board certified chiropractors and certified in full body Active Release Technique. We examine the patient and determine the most efficient and quickest treatment plan for them. Our goal is not only to get the athlete back out on the field doing what they love to do, but to also enhance their athletic performance. We address the scar tissue that is built up from micro tears in the tissue due to overuse or previous injuries and develop a program to strengthen and train the muscles to be used functionally. Most all of our patients find results within a few treatments with decreased pain, and increased range of motion, strength, and balance. We then move into the second phase of treatment with strength and conditioning which is the most important aspect of the treatment, to prevent future injuries.
In summary, to address foot numbness:
Address the scar tissue in primary involved muscle, and any associated muscle
Warm up and stretch the foot and ankle muscles
Strengthen and condition the direct and indirect muscles of the ankle prevent future injury (sport specific functional training)
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Board, A.D.A.M. Editorial. "Fibromyalgia." Fibromyalgia. U.S. National Library of Medicine, 02 Feb. 2012. Web. 28 Aug. 2013.
Zieve, David, MD, and Luc Jasmin, MD, PhD. "Multiple Sclerosis: MedlinePlus Medical Encyclopedia." U.S National Library of Medicine. U.S. National Library of Medicine, 26 Sept. 2011. Web. 28 Aug. 2013.
Ogiela, Dennis, MD, and David Zieve, MD. "Herniated Disk: MedlinePlus Medical Encyclopedia." U.S National Library of Medicine. U.S. National Library of Medicine, 07 June 2012. Web. 29 Aug. 2013.
Steinmehl, Eric. "Diabetes Overview." Healthlines RSS News. Healthline Networks, 09 Aug. 2012. Web. 29 Aug. 2013.
AAOS. "Posterior Tibial Tendon Dysfunction-OrthoInfo - AAOS." Posterior Tibial Tendon Dysfunction-OrthoInfo - AAOS. American Academy of Orthopaedic Surgeons, Dec. 2011. Web. 29 Aug. 2013.