Case(s) of the day!

Well, today has been a plantar fasciitis day.  Sometimes it goes like that.  Everyone who walks through the door seems to have heel pain!

And today was a good day to remember that sometimes the pain that you get is actually a symptom of a problem elsewhere up the chain... and plantar fasciitis is a good example of just that!

So recalling today's case.  Heel pain for 20 months!  Has had to give up running.  Two steroid injections to heel, a 5 week course of shock wave therapy, one visit to an Orthopaedic surgeon, many visits to various physios, a course of acupuncture (at great cost), a chiropracter and a podiatrist.  And still heel pain.

So what do we find today?

Yes, heel pain.  But what else....well.... a right calf tear about 2 years ago (heel pain is on the right) with no rehab after the tear.  Ankle injuries playing hockey (although can't remember what side). 

On examination: a stiff right talocrural (ankle) joint, a stiff subtalar joint (lower part of ankle/foot joints), a stiff midfoot and a 'dent' in the medial side of the right calf where the medial gastroc should be!  Poor glute activation, poor glute max strength on the right, poor hamstring strength on the right (and left but to lesser extent).  And a positive slump test with evidence of neural tethering with the right foot held into eversion as the knee is extended. 

Ultrasound showed a right medial head of gastroc with a significant are of scarring as well as a thickened and disorganised plantar fascia.

The plan:
1) calf strength work
2) glute activation and strength work
3) hamstring strength work
4) physio mobilisation to the stiff right ankle (subtalar joint, talocrural joint, midfoot joints)
5) massage and acupuncture to the right medial gastroc to help allieviate some of the scarring.
6) no impact work - no running - running in the pool only, cycling if able, cross trainer if able, swimming
7) balance and proprioception
8) neural 'flossing' exercises

I can't guarantee it will work.  It's been a long time.  But I am convinced that the heel pain is a symptom...the sore throat equivalent of having a virus...with the virus being the stiff ankle and weak calf muscles. 

Most pain is secondary to an injury.  But that injury may be being provoked by a problem elsewhere and until that is dealt with the injury will remain.  Often the case in 'overuse' or 'overload' injuries.  The clue is in the title!

And sorry - next time I'll get a picture to make it more interesting!  If you want some pictures then just google (image) plantar fasciitis!