|
|
RE: Plantar Fascitis ideas?
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
RE: Plantar Fascitis ideas? - July 27, 2008 10:33:50 AM
|
|
|
jma
Posts: 2409
Joined: August 24, 2000
From: NY
Status: offline
|
Thanks for that link. Very helpful
|
|
|
|
|
RE: Plantar Fascitis ideas? - July 27, 2008 11:21:52 AM
|
|
|
Sebastian Asselbergs
Posts: 1191
Joined: September 29, 1999
From: Barrie, Canada
Status: offline
|
Duffy, I fully agree with your endorsement of NB600 shoes. Indeed often enough for those early stage foot related problems.
_____________________________
Mundi vult decipi
|
|
|
|
|
RE: Plantar Fascitis ideas? - July 27, 2008 7:33:08 PM
|
|
|
blast7
Posts: 114
Joined: July 28, 2005
Status: offline
|
No problem. Just a side note, I thought I linked it directly to the shoe selection so if you are looking for specific running shoes just look at the link at the very bottom of the original link, titled running shoes.
|
|
|
|
|
RE: Plantar Fascitis ideas? - July 28, 2008 3:42:35 PM
|
|
|
torques
Posts: 59
Joined: July 18, 2008
From: Marion, IN
Status: offline
|
Hi Steph,
This is my very first posting. I would like to comment on your case. Plantar fasciitis typically is cause by biomechanical fault imposed on the plantar fascia. This fault can be caused by abnormal structural and movement dysfunction. Understanding foot arthrokinematics and foot dynamics during gait and other functional activities are keys in effective treatment of this disorder. Abnormal foot type is not always the culprit for dysfunctional foot but it predisposes the foot to certain pathology. I highly recommend Gary Gray's video course on chain reaction (his video series on functional biomechanics is great) and "Orthotic Reaction" course for basic foot mechanics.These courses can provide you with further understanding of functional anatomy/mechanics of the foot. In practice, I always assess calcaneal eversion mobility and ankle dorsiflexion (both with calcaneus in eversion and inversion). I commonly see dysfunction in this region. In quick glance, observe signs of foot overpronation (especially the longitudinal midtarsal joint axis) and trouble shoot what's jamming the talonavicular/ MT joint down. Clearing the talocrural and subtalar joint motion will help releasing strain on plantar fascia. Mid/Forefoot dynamics are secondarily assess:calcaneonavicular, calcaneocuboid and first/fifth ray mechanics. Soft tissue assessment cannot be overlooked. I always check the muscle belly of the foot muscles. You'll be amaze how some of these muscles away from the foot are reactive (evertors, foot flexors et.al) Plantar fasciitis is being used a lot by physicians without performing differential diagnosis for other likely cause of plantar/medial foot pain. Make sure to rule out other dysfunction (e.g. posterior tibialis dysfunction, stress fracture, tarsal tunnel syndrome et al). I don't do direct manual technique on the fascia itself other than utilizing some gentle fascial stretching. Manual therapy of ankle joint I find more appropriate and sometimes the hip which also influence the foot/LE mechanics especially the lack of hip internal rotation. Following manual therapy, I have patient do lunge stretch with intent to increase true ankle dorsiflexion and subtalar eversion. (Ankle DF can be tight in loading phase-with foot in pronation or in unloading phase-with foot in supination). Reinforce the treatment with motor control retraining to develop foot stability. BAPS board, functional exercises (I like lunges, single leg stance with opposite leg reaches).
I don't readily utilize orthotic intervention. If ever I see the need for support i usually recommend over the counter full length arch support and I may do some modification if needed. (forefoot/rearfoot postings.). You can find cheap posting items in podiatric supply catalogue. Alimed carry it among others. Biomechanically observe changes in patient dynamics, post orthotic intervention. Assess balance in functional tests. (this can be learned from Gary Gray's course). Stability and balance can be good indicator if orthosis is providing benefit.
Lastly, examine the shoes. Make sure the shoe itself is not feeding to the dysfunction. In some cases, changing shoes may just resolve the problem. Be familiar with basic shoe fit especially with certain dysfunctional foot type. I know a lot of PT's are not so familiar with footwear. Pedorthic courses are available and PT's I think are welcome if you want to further understand shoe and foot orthotic function. I hope I have provided some insight on the case.
 Julius Quezon, PT MTC CPed
|
|
|
|
|
RE: Plantar Fascitis ideas? - August 8, 2008 1:56:21 PM
|
|
|
flintstearns
Posts: 1
Joined: August 8, 2008
Status: offline
|
Anodyne treatment can help.
|
|
|
|
|
RE: Plantar Fascitis ideas? - August 8, 2008 3:53:38 PM
|
|
|
jlharris
Posts: 476
Joined: April 12, 2006
From: Nebraska
Status: offline
|
quote:
ORIGINAL: flintstearns
Anodyne treatment can help.
Yeah, but most likely only the manufacturers and practicioners bottom line.
If you want to reduce pain, use cryotherapy. We now it works, and it can be done w/ little of no cost to the pt; and be done when THEY want it.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
|
|
|
|
|
RE: Plantar Fascitis ideas? - August 9, 2008 12:16:25 AM
|
|
|
ginger
Posts: 658
Joined: February 26, 2005
From: Melbourne Victoria
Status: online
|
haven't come across a " plantar fasciitis" or an " achilles tendinosis' that could not be eliminated permanently by Cm to L5/S1 in one or two treatments, for many years. The problem for physios who seem to be unable or unwilling to shift their attention away from the site of pain , is that there are numerous short term treatments that make a difference to these problems, sufficient in some cases to keep their minds and hands focussed on the wrong part. It is only by shifting focus onto the source of these nerve irritation type problems, that the light may come on.
|
|
|
|
|
RE: Plantar Fascitis ideas? - August 9, 2008 6:43:40 AM
|
|
|
torques
Posts: 59
Joined: July 18, 2008
From: Marion, IN
Status: offline
|
Hi Ginger,
I agree with your notion about looking at other region for true source of dysfunction. In all cases, I tend not to accept medical diagnosis until I thoroughly complete the examination and evaluation of a patient. I see few patients with same symptom like you state(achilles tendinosis/tendinitis) that is actually neurogenic. The way I address the issue is I lay the foundation to where I can communicate such findings. Neuro testing is definitely a must. I do mechanical loading assessment to observe symptom change (centralized/peripheralized). If pain centralized and neuro test turns positive such as diminished S1 DTR or deficit in dermatomal/myotomal level particularly S1 distribution and any of the special tests (SLR,Slump, PKB, PNF et al), and tenderness/segmental dysfunction L5S1. Then I would relay my findings to the physician(e.g. mechanically reducible disc syndrome L5S1)
Ginger, what is cm? I assume is central mob L5S1. I will try your technique. Are you doing Maitland graded oscillation technique? I typically have patient perform (extension based exercises) like prone press up until patient completely have symptom resolution. I find McKenzie greatly effective especially in milder case of discogenic problems. PA oscillation L5S1 I think work in same principle with Mckenzie in some respect(you are just using more arthrokinematic (joint play) motion versus osteokinematic movement) I read an article about comparing PA joint mobilization and prone press up in LBP. Cant remember if it is in JOSPT or PT Bulletin. They found no difference in outcome. Your strategy might work well in patients who dont do well with exercises. I rarely do graded oscillation mobilization. I guess I need to start practicing. I am so use to doing progressive oscillation and thrust techniques. I find it quick and easy especially in increasing segmental mobility. I have yet to explore Low grade oscillation in reactive/hypermobile segments(maitland).
Julius Quezon PT DPT MTC CPed
|
|
|
|
|
RE: Plantar Fascitis ideas? - August 9, 2008 7:18:05 AM
|
|
|
ginger
Posts: 658
Joined: February 26, 2005
From: Melbourne Victoria
Status: online
|
CM stands for Continuous Mobilisation , it is a unilateral technique, based on the notion that pain is part of a protective response which must be detuned or turned off . CM will do this. Look in the archives in manual therapies with CM as ky word, also look for "the physiology of spinal Pain' for further explanation.
Cheers
|
|
|
|
RE: Plantar Fascitis ideas? - August 10, 2008 2:31:10 AM
|
|
|
gomez2
Posts: 51
Joined: May 5, 2005
Status: offline
|
I agree with Ginger, the answer is elsewhere. I like many others learned the when the foot hits the ground and the injury focused approach. In the last 5 years I have started to look at overall biomechanical function of a client and look at where the inefficiencies are.
I have treated PF both directly and indirectly by addressing and correcting hip alignment and effiency through a series of progressive exercise routines, mostly hips but overall body as well. My goals are to establish bilateral muscular activation throughout the body, establish proper AROM, proper muscular balance and postural re-alignment and then begin re-educating proper muscular coodination through full ROM then add demand to reinforce the new proper biomechanics.
My demo for my clients to illustrate the importance of hip function to the allignment and function of the knees and ankles: stand and lock the knees tight, rotate the femurs in towards each other then outwards. As the hips are IR the feet pronate creating a "flattening" stress on the arch, as the hips ER the feet supinate decreaseing stress on the arch allowing the interosseous nuscles to re-establish the arch.
I have had clients work themselves out of custom orthotics as they re-establish proper hip then foot alignment, also clients have had to get new shoes as they go from severe supination and pes cavus to proper foot alignment and their feet WB properly and the feet acually get larger.
Look at the client's posture in all 4 directions for alignment as well as gait. I would bet she is IR in 1 or B hips
Lifts and supportive shoes would work but is really not addressing the origin of the problem, it is bracing and bandaging the pain.
www.adapttraining.com
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.141
|
Printable Version
