What are the treatment options for posterior tibial nerve entrapment?

Updated: Oct 15, 2019
  • Author: Minoo Hadjari Hollis, MD; Chief Editor: Thomas M DeBerardino, MD  more...
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Treatment of posterior tibial nerve entrapment (tarsal tunnel syndrome) is directed toward the underlying etiology of neural compression. Nonoperative options can include the use of NSAIDs (in cases associated with inflammation), aspiration of underlying cystic lesions, and control of edema and varicosity. Medical treatment of underlying systemic conditions is helpful in the indicated situation. The use of antineuritic medications (eg, gabapentin and, occasionally, TCAs) has also been shown to alleviate symptoms in many patients.

At times, a trial of immobilization with the use of casts or walking boots is indicated. Orthotic management is indicated in patients with proximal entrapment and alignment or postural abnormalities causing chronic traction or compression trauma to the nerve. In patients with distal entrapment and associated heel pain, the use of accommodative orthotics with a relief area in the anterior heel pad (ie, under the posterior tibial nerve) is usually helpful.

Patients with flatfoot may benefit from semirigid University of California at Berkeley Laboratory (UCBL)-type orthotic devices with a deep heel cup to minimize weightbearing traction on the nerve.

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