yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
Status: offline
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I need help with this one:
40 year old female s/p right tarsal tunnel release (4/13/06); referred by podiatrist for pain, plantar fasciitis, and metatarsalgia. She states chronic numbness in toes 3-5 (as well as tenderness to the touch over the dorsum of the foot), pain along incision posterior to the medial malleolus that follows course of posterior tibialis and into proximal plantar fascia. There is noteable swelling at plantar fascia, tenderness and decreased mobility at surgical site. Also has history of "sciatica" and "bulging disc" per her report, treated with chiropractic some time ago. Pain also in right posterolateral hip. She complains of a drawing up and cramping of her second toe that she cannot relieve. Pain in all areas is only slightly worse with gait; it is mostly constant and can be 6/10. In subtalar neutral, she has a neutral foot, flexible. Somewhat decreased pronation control at right stance phase compared to uninvolved side.
She is weak in FHL, peroneus tertis, anterior tib, and posterior tib. Positive neurotension in posterior tib n., peroneal n., and scatic n. - although I'll admit that I am not the best at these assessments or treatments. She is also tender to mobs at right L3-L5.
As you may suspect, surgery has not really helped her pain. Any advice or guidance on further assessments or treatment approaches would be helpful and much appreciated.
Thanks,
Eric
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Eric Yarrington, PT, MPT, OCS
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