The Effectiveness of Neural Mobilization in Patients with Tarsal Tunnel Syndrome: A Systematic Review and Meta-Analysis

Petros I Tatsios, Eirini Grammatopoulou, Irini Patsaki, Sotiria Vrouva, George A Koumantakis

Abstract


Background: Tarsal Tunnel Syndrome (TTS) is a compression neuropathy, occurring when the distal branches of the posterior tibial nerve become entrapped within the tarsal tunnel, with no definitive evidence for its conservative management. Neural mobilization, a therapeutic approach involving joint and peripheral nerve movement, seeks to restore the nervous system’s homeostasis. There is currently insufficient evidence to determine the efficacy of neural mobilization. Objectives: Analysis of data from randomized controlled trials (RCTs) examining the efficacy of neural mobilization techniques (NMT) in TTS patients. Methods: A thorough search was carried out from inception until September 2024 utilizing four scientific databases (PubMed, Scopus, EMBASE, and Physiotherapy Evidence Database-PEDro) and the Google Scholar search engine. Relevant English-language research was retrieved, assessed, and given an independent methodological quality rating (PEDro scale). Meta-analyses were conducted for select outcomes, where possible. Results: 745 studies were eliminated from the total of 748 because they were duplicates or did not fit the inclusion criteria. Three RCTs were finally included, rated on average with 6.67/10 for methodological quality (PEDro scale). NMT led to a highly significant improvement of the nerve’s physiological sensitivity (p<0.001), measured with the Tinel’s sign, based on evidence of high methodological quality (7.5/10) and no heterogeneity. NMT did not lead to a significant diminution of pain intensity (p=0.21) based on evidence of moderate methodological quality (6.67/10). Significant improvements in favour of NMT, however measured in one out of three studies, were identified for 2-point discrimination and light touch, the Neuropathic Pain Questionnaire, and the Functional Foot Index (p<0.05). No adverse events were reported. All studies measured change immediately post-treatment. Conclusion: NMT significantly improved the tibial nerve’s mechanosensitivity. Moreover, as part of the treatment of patients with TTS, high-quality RCTs are necessary to examine the short and longer-term effects of NMT.


Keywords


Tarsal Tunnel Syndrome, Nerve Compression Syndromes, Flatfoot, Entrapment Neuropathy, Tibial Neuropathy, Rehabilitation

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References


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DOI: https://doi.org/10.7575/aiac.ijkss.v.12n.4p.63

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