Peripheral nerve entrapment of the tibial nerve are an important consideration in foot ankle and heel pain. Sensitivity of the tibial nerve may occur for various reasons including entrapment in the tarsal tunnel, secondary sensitisation of the tibial nerve from a tibialis tendinopathy of FHL tendinopathy. Fractures and medial ankle sprains can also cause secondary sensitisation of the tibial nerve.
The upregulation of inflammatory chemical can sensitise the nervi nevorum of the tibial nerve and lead to neuropathic symptoms. With a compressive neuropathy such as in tarsal tunnel syndrome, the tibial nerve is deprived of blood supply and therefore becomes ischemic, and hypoxic leading to neurogenic inflammation and sensitisation of the tibial nerve.
With persistent pain it is essential that we assess if there is peripheral nerve involvement as this can often be over looked in plantar heel pain.
Neurodynamic sliding techniques promote movement of the nerve through its mechanical interface and therefore increasing blood flow and oxygen which is essential to the health of the nerve. Regular neurodynamic sliders to a sensitised nerve has a pumping effects on the nerve and surrounding tissue that can decrease neurogenic inflammation and therefore decreases sensitivity.
As always it is first important to conduct a neurological screen and rule out the lumbar spine and any other conditions that may present with similar symptoms
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