It's been a foot centric week here at The Manual Therapist! Be sure to check out Monday's post on foot orthotics Q&A and Adam Kelly's Post on his toe orthoses and dynamic balance if you haven't already!
This was a request from my facebook page, so without further ado, here are 5 Patterns of Plantarfasciitis
1) Loss of Ankle Dorsiflexion
- duh! - actually, the df loss is specifically with "straight" ankle df
- the foot often compensates with a lateral posterior talar glide, causing forefoot eversion, often leading to more pronation than normal
- the foot still dorsiflexes, but not with the knee going over the 2nd metatarsal as it is supposed to
- other than the half kneel ankle df test, I make sure to measure it passively with knee bent and straight, with the forefoot in neutral, controlling for eversion
- this often makes a firm end feel (eversion), into a hard end feel, indicating manual therapy
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| another runner with unilateral lower quarter issues, guess which side? |
2) Loss of Tibial IR
- this is just a chain effect of the forefoot everting with each step, often worse with more dynamic activities such as running, jumping, or squatting
- so this is chicken or the egg, but either way, improving tibial IR by working on lateral lower leg patterns with IASTM and functional mobilization of the tibia, you can rapidly get dorsiflexion and tibial IR back in almost 90% of cases
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| she has knee pain and runs, are you surprised? |
3) Loss of dynamic balance
- I am a fan of the single leg step down/squat test to check for dynamic balance
- I also use motor control theory when prescribing exercises, a tip I got from my friend Charlie Weingroff
- if someone is not rock solid on SLS activities, do you throw them on a dyna disc?
- how are they supposed to get rock solid on normal ground if they are on an unstable surface?
- I have them practice the SLS with anti-rotation (therband chest press) - pulling toward leg side up, statically holding a kettlebell, or pushing a dowel into the ground
- when they're rock solid without assistance and through resistance, THEN put them on unstable surface
- this tweak tape is a favorite trick of mine as well, easy enough to apply, and stayed on a few of my patients who were marathoners the entire race!
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| does the path of this nerve look incriminating for plantarfasciitis? |
4) Neurodynamic saphenous nerve dysfunction
- neurodynamic dysfunction may mimic or contribute to the pain state of plantarfasciitis due to the path of this nerve
- to review: biasing the saphenous nerve involves
- hip flexion, IR, adduction
- knee extension
- ankle dorsiflexion and eversion
- I demonstrate this toward the end of this video
- if this is positive, I tend not to do the saphenous mobilization, as it may be provocative
- instead, I do light IASTM along the path of the nerve, or wrap the lower leg (circumferential) or ankle in an EDGE Mobility Band (figure eight around ankle) to modulate the neurodynamic tensioner
5) subtalar mobility dysfunction
- an OMPT mainstay, often forgotten by myself in the days of MDT and SFMA until recently in a plantarfaciiitis case
- all of the above was working, but she had transient relief until I assessed her subtalar mobility with calcaneal rocks
- to review: cup a hand on the calcaneus and another stabilizing the distal tibia
- rock the calcaneus in three planes to check for limitations
- IR/ER - axis of rotation superior/inferior
- pf/df - axis of rotation medial/lateral
- valgus/varus - axis of rotation anterior/posterior
- the case mentioned above was limited in calaneal IR, and after some mobilizations and IASTM around the calaneal bony contours, she was walking much better
- I taught her how to self distract and added a little wiggle to improve IR as well
Remember to use a Strassburg sock as well, which really helps cut down on visits for plantarfasciitis. It was invented by a fellowship mentee of mine and fellow Buffalonian!
Keeping it Eclectic despite a general lack of quality sleep....
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