Medial plantar nerve entrapment is symptomatic compression of the medial branch of the posterior tibial nerve at the medial heel.

Symptoms include almost constant pain, with and without weight bearing. Simple standing is often difficult. Burning, numbness, and paresthesias are usually absent.

Diagnosis

• Clinical evaluation

Medial plantar nerve entrapment may be confused with plantar fasciosis and heel spur pain as well as tarsal tunnel syndrome. In medial plantar nerve entrapment, the following are present:

• Tenderness is at the medial heel.
• Other signs of tarsal tunnel syndrome are absent.
• Symptoms can be reproduced by palpation over the proximal aspect of the abductor hallucis, the origin of the plantar fascia, or both at the medial tubercle of the calcaneus.

Treatment

• Orthoses, immobilization, and physical therapy

Immobilization and foot orthoses to prevent irritating motion and pressure may be helpful, as may physical therapy and cryotherapy. If these treatments are ineffective, injection with a sclerosing agent that contains alcohol or careful surgical decompression of the nerve may help relieve pain.

Last full review/revision March 2008 by Kendrick Alan Whitney, DPM