49-YEAR-OLD FEMALE WITH BILATERAL PLANTAR FASCITIS
Medical Hx:
Podiatrist: orthotics for pronation control, Injections into heel for pain reduction, Oral medications
Primary Care Provider: Blood work and oral medications
Rheumatologist: trial of medication for potential autoimmune disease causing the pain
Patient has spent the last two plus years in constant pain in the bottom of her heel and foot. Her activity levels have decreased significantly and hope for reduction in pain is weaning.
Intrinsic Assessment:
Right calcaneus bone fixed in a medial or everted position causing the right calve muscles to become extremely tight. The tension on the muscles has created a constant pressure on the ligamentous attachment site at the plantar (bottom) surface of the heel.
Left Navicular joint fixed in an elevated position which is causing limited plantar flexion (pointing the toes). Limited mobility forcing ankle joints to stiffen creating left foot and ankle pain. Some added tension in the calve muscles.
Intrinsic Treatment:
Mobilize the ankle joints then elongate the calve muscles through a combination of PNF stretching and Active Release Techniques (ART). Ankle mobility exercises using TheraBand straps. Break up adhesive tissue at plantar region using tool-based techniques. Adjust and stabilize low back region through adjustments and intrinsic muscle stability exercises. Support muscles and soft tissue with kinesio tape post treatment. Gait and balance training using BOSU ball and balance apparatus.
EXPECTATIONS:
Pt will heal and recover withing 4 weeks