Medial calcaneal nerve is an important nerve of the foot that mainly innervates the heel region and sole of foot. It arises from the posterior tibial nerve, and is formed at the level of the medial malleolus. The heel region depends on it to get connected to brain. In some cases the medial calcaneal nerve arises from the posterior tibial nerve indirectly through the lateral plantar nerve. It may get compressed between the structures like bones, ligaments and fascia and problems may arise to cause much discomfort. Usually the runners get such compression as a lot of load is put on the heels and excessive movement may cause the nerve to get entrapped between any two structures. In severe cases the entrapment may progress to the trauma of nerve because of increased friction and mobility.
What causes the medial calcaneal nerve to get entrapped?
The nerve passes through many structures after getting origin and usually gets entrapped between a mobile and the static structure. An excessive pronation of foot is a major cause of the nerve entrapment. It gets trapped between the tight fascia of the abductor hallucis muscle and the calcaneus bone. The stretch fractures of the calcaneus and navicular also cause the entrapment of medial calcaneal nerve.
Signs and symptoms of medial nerve entrapment:
Major manifestations of the medial calcaneal nerve are following:
- Burning pain in heel region
- Parasthesia
- Positive tinel’s test
- Radiation of pain to sole and ankle
- Pain aggravation on running
- Tenderness over affected area
Diagnosis:
Tinel’s test is a good modality in checking whether medial calcaneal nerve is intact and free or not. The area supplied by the medial calcaneal nerve is tapped with some pen or hand gently and patient is asked about the tingling sensation. In case of entrapment, the tingling is there. Electrophysiological techniques are also used that are more authentic and check the normal functioning of the medial cacaneal nerve in short time. Other physical techniques like David Butler’s test may also be used.
The nerve conduction studies confirm the diagnosis. Inject a local anesthetic at the affected site, and if tenderness and pain is gone, it is the matter of nerve entrapment.
How to treat medial calcaneal nerve entrapment?
There are many options available to relieve the pain and discomfort caused by the compressed or entrapped medial calcaneal nerve. Here are some:
- Foot rest is the first and foremost thing to do so that nerve does not get irritated more and nerve trauma can be avoided. Healing will also be rapid due to rest.
- Pain killers are used to get rid of pain and anti-inflammatory drugs like ibuprofen are taken to resolve the inflammation and tenderness. An injection of corticosteroids is given if problem gets severe and not relieved by ordinary medicines.
- Specific orthotics or inserts should be used to prevent over pronation of foot.
- If everything fails to give relief, surgical method is adopted to get nerve out of entrapment and compression.