Hi crew,
Hope the placements are going well. I’m currently on my musculoskeletal placement and the question I have may have no further answers but I wanted to see if there is anything else I can try to help one my patients. This particular patient is an avid runner that is currently unable to even walk long distances due to chronic heel pain. She has been into the clinic prior to X-mas and I’ve had two sessions with the patient. The patient has the common complaints of a constant feeling of discomfort in her heel during the day that increases to 7/10 with impact activities such as running and walking that has continued over the last 3 months. She reports of no acute incident that started her heel pain and that her complaints have not receded even after stopping her walking/running over the holidays. The patient is now very frustrated due to the fact that she is unable to perform the activities that she loves. The diagnosis has changed between a fat pad contusion and plantar fasciitis depending on the response to treatment, but I’m fairly certain that the fascia is the source of the complaints.
The patient complains of pain at the insertion site of the plantar fascia on the medial portion of the calcaneus. Both feet are extremely flat but the affected foot is slightly more pronated and has reduced gastrocnemius and soleus muscle length as well as reduced ankle AROM into dorsiflexion. Also compared with the fascia on other foot, there is a visible and palpable increase in tension in the fascia itself. Interestingly enough there is actually a decrease in muscle length of the flexor hallucis longus on the symptomatic foot, a measure that was determined last session.
Treatment so far has consisted of STM of the gastroc/soleus muscles and the plantar fascia itself in addition to the low dye taping of the foot. The home exercise program consists of stretching of the plantar fascia, gastrocnemius and soleus muscles. She has recently had some orthotics made and is using them regularly. We are also trialling a walking program which she started last week consisting of a 4km walk on grass 3x/week and progressions in her frequency and level of impact will occur according to the response of her heel complaints.
As I don’t have a huge amount of experience with this type of injury, I was wondering if anybody has other treatments options that I could apply to her sessions or is my management of the patient’s heel complaints the area where I’m going to have the most impact in her recovery. Because at the moment, I feel limited in the treatments options that I can provide for the patient. I know that management of a patient’s daily activities is a huge portion of being a physiotherapist but I guess would like to have a larger role in her return to running through actual treatment techniques/options.
Gareth
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Hey Gareth
Funnily enough we had a tutorial in our neuro placement today on foot mobs for ppl who had suffered a stroke and the side-comment my supervisor made at the end was that these mobs had worked well for her when treating ppl with plantar fasciitis! I think we did briefly go over them in class, or at least they were in a lecture/lab notes for neuro last semester.
What they involve is placing the clients foot on youre thigh (they are SOEB or on a chair, you kneeled on the floor in front of them, at a right angle to them), with your proximal hand under the calcaneus and your distal hand over the talus anteriorly. You slowly rock your pelvis side to side, which induces youre thigh to move and so too their foot, with your hands encouraging this rocking movement. You move the fot over your thigh from the heel to the toes while ensuring the talus is moving properly. I think this was the main one for treating plantar fasciitis, but you can then move to the mid foot and promote adequate inversion/eversion here whilst stabilising the forefoot. Hopefully this explanation is sufficient for you to have a go!
Bini
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