Common problem unusual presentation - Stumped!!
Hello All
You know that thing where you wait for a bus for hours and then 4 come along at once, that thing where you see something odd and unusual and then three more people come in with it that weeks??
Well recently 4 people have come into my clinic with a common complaint but with unusual presentation and it's stumping me a bit as to what sort of orthotic design and treatment program I should prescribe.
The complaint is in all four cases plantar facsiitis, no doubt that this is the diagnosis, pain along the PF band as the hallux is dorsiflexed and it tensions and pressure is applied to the PF along its length and particularly painful to pressure on the medial tubercle of the calc.
Open chain, the STJ axes are very lateral, STN is inverted with normal RoM. The forefoot is slightly valgus, the 1st ray is compliant but the MPJ is not low. The feet are fairly cavus open chain but have compliant midfoot joints, so the long arches are able to displace significantly if so loaded.
In stance the feet/STJ are supinated and have very light supination and jacks test.
In gait the feet supinate in heel strike to early stance, pronate from a supinated position in mid stance and supinate in late stance/propulsion. Ankle RoMs were similar in nature but none were very equinus or stiff although they all could be better and were improved with Mobs. None appeared to be using the peroneals excessively or out of normal phase but this is difficult to assess, and none had any peroneal pain.
None of them were serious runners if at all, although all of them would run/jog or run/jog more if the feet didn't hurt. All of them had post static pain, which eased with walking but got worse again with long walks. They all had mid to forefoot strike in running gait with large range of pronation from inverted forefoot strike to pronated propulsive phase.
AM3 pressure mat scans do not indicate significant saggital plane progression perturbation although 2 do appear to have some indication of FncHL in late stance phase but the total medial forces (taking into account the light supination / jacks test) applied to the foot and 1st MPH would be relatively low one might assume.
So two problems here:
1)What mechanism is causing the stress,? Why do they have plantar Fasciitis in the first place when they seem like unlike candidates who would not seem prone to such excessive stress in those tissues.
2) What design of orthosis can I use, I’m not sure about the mechanism and anything that supinates the foot will likely cause inversion sprains.
Regards Dave Smith
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