The effects of tibial nerve mobilization in patients with tarsal tunnel syndrome: A randomized controlled trial

In tarsal tunnel syndrome (TTS), the nerve mobilization, one of the conservative treatment methods, aims to relieve abnormal nerve tension with appropriate movements of the nerve tissue. The aim of this study was to investigate the effect of tibial nerve mobilization in addition to home exercise on the tibial nerve area in patients diagnosed with TTS. The study included 40 participants, 20 cases allocated to the intervention group (IG) and 20 cases to the control group (CG). IG received tibial nerve mobilization and a home exercise program for the foot-ankle joint. Participants in the control group had only a home exercise program for the foot-ankle joint. Primary outcome measures were tibial nerve diameter and Tinel's sign measurements. Secondary outcome measures were pain intensity, neuropathic pain status (NPQ) and the foot functional index (FFI). The positive Tinel's sign incidence was lower in favour of the IG group (Odds ratio:0.11 95% CI: 0.03 to 0.46). Between-group comparisons revealed a significant difference in pain intensity (Mean difference: 1.45; 95% CI: 0.69 to 2.20), NPQ (Mean difference: 0.70; 95% CI: 0.36 to 1.03), pain subscale (Mean difference: 10.0; 95% CI: 4.33 to 15.66) and total score of FFI (Mean difference: 20.60; 95% CI: 0.53 to 40.66) in favour of the IG group. There were no reported adverse events. This study showed that the addition of tibial nerve mobilization to home exercise program might improve symptoms, especially pain and functionality in patients with TTS. Further studies with large sample sizes are need to support these results.