Tarsal tunnel orthotic groove?

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I hoping for some help. A Orthopaedic surgeon has asked me to provide an orthotic for a patient that he believes has tarsal tunnel syndrome and he has asked that I incorporate a "groove" for tarsal tunnel that he tells me is suggested by Gould?

I can find no such mention of any "tarsal tunnel groove" in an orthotic.
Anyone else know of it?

 

Gould makes no such suggestion:


Tarsal Tunnel Prescription Recommendations:

Polypropylene Shell - semirigid

Deep Heel Cup - deep cup helps limit heel eversion

Wide Width - wider width through the arch increases surface area under the arch preventing arch collapse.

Minimum Cast Fill - minimum cast fill creates an orthosis that conforms closely to the arch of the foot and helps prevent arch collapse

Medial Heel Skive – 4mm - the medial heel skive creates a greater force medial to the axis of the subtalar joint helping to reduce excessive STJ pronation and heel eversion

Inversion – 2 degrees - Inversion of the positive cast increases arch height in order to prevent medial arch collapse

Rearfoot Post - Heel Lift – 4mm - The heel lift encourages ankle joint plantarflexion


Summary
An orthosis prescribed for the treatment of tarsal tunnel syndrome should decrease heel eversion, prevent medial arch collapse and encourage mild ankle plantarflexion. The orthosis described is designed to decrease tibial nerve traction and is based on the current medical literature.

www.prolaborthotics.com/Products/PathologySpecific

 

I wrote a Precision Intricast Newsletter in July 2010 on:

PRESCRIBING BETTER FOOT ORTHOSES: TARSAL TUNNEL SYNDROME

that is now published in my fourth book (Kirby KA: Foot and Lower Extremity Biomechanics IV: Precision Intricast Newsletters, 2009-2013. Precision Intricast, Inc., Payson, AZ, 2014, pp. 97-98).

In this newsletter I describe the foot orthosis modifications I use in patients with tarsal tunnel syndrome.

Also, in this regard, I coauthored a paper published over two decades ago in the American Journal of Sports Medicine about a power lifter that I treated with foot orthoses who showed a change in nerve conduction velocity once his lateral plantar nerve entrapment was successfully treated with my foot orthoses (Johnson ER, Kirby KA, Lieberman JS: Lateral plantar nerve entrapment: Foot pain in a power lifter. Am J Sports Med, 20 (5):619-620, 1992).

http://www.ncbi.nlm.nih.gov/pubmed/1443336

 

In my own practice, I cannot recall a single patient that responded to orthotics for a true tarsal tunnel either long enough or symptomatically enough to avert surgical intervention. In fact, many chronic tarsal tunnel patients do not have enough room in their closet for another pair of orthotics.

I'm sure Dr. Kirby has some success and I do not wish to dissuade the use of orthotics nor question his expertise.

I do think much further and detailed evaluation of each and every "nerve pain" patient is needed in order to further define the etiology rather than bundling all medial nerve pain patients into a "Tarsal Tunnel" label and treating them.

Steve

 

Many thanks for your replies. They are much appreciated. I am familiar with the Inversion/Skive technique. I have been given a copy of the paper today and John Gould MD. discusses using a soft soft for the area of nerve compression;

"For nonoperative treatment, my colleagues and I use a custom total contact insert
with a posteromedial nerve relief channel (Fig. 4).13 The channel is placed in the medial
wall of the heel component and to the midline in the plantar area. The channel corresponds
to the anatomy of the lateral plantar nerve and its first branch and is placed
within the cork, which is used for posting the heel and longitudinal arch. The channel is
filled with a viscoelastic polymer. When a patient’s diagnosis is central heel pad
syndrome or the tenderness is also in the central heel pad in distal tarsal tunnel, the
channel is extended more posteriorly both medially and plantarward. When the medial
plantar nerve seems to be involved, the distal edge of the channel is feathered and the
channel may be continued along the medial longitudinal arch. When a distal tarsal
tunnel is treated with a more standard insert, without the channel, the patient often
states that the insert makes his problem worse. Adding the channel may be dramatic
in providing relief. Although there are no hard data to confirm this impression, my
colleagues and I think that approximately two-thirds of never-operated patients
respond positively to the use of this insert alone."

This is the paper attached.
View attachment 2011 Foot and Ankle Clinics Gould.pdf