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Monday, January 16, 2012

Flexor Hallicus Longus and Plantar Fasciitis...

Do you have plantar fasciitis?  Do you have a patient or a client who has plantar fasciitis?  Does the fasciitis keep coming back time after time?  If you answered yes to any of these questions you will find this post extremely helpful.

Ok, so you have properly diagnosed that patient X has Plantar Fasciitis (PF for the purpose of this post).  Winner Winner chicken dinner!  What does this diagnosis tell you other than their plantar fascia is inflammed?  Not much...  We need to figure out WHY they have developed the PF in the first place.

Here are some thoughts/suggestions/ideas.  The only one below that you must do first, is #1 (in my opinion)

Step 1- Look at their gait and watch them MOVE.  You WILL find some faulty movement patterns that are leading to the increased stress on the planar surface of the foot...

Step 2- Look at their Gastroc/Solues Complex for facilitated muscles and restricted fascia (This should not be rocket science)

Step 3- Look at the distal tib-fib joint.  If this is restricted and leading to decreased dorsiflexion, something has to compensate and usually the PF will become irritated

Step 4- Flexor Hallicus Longus!  This is a major key to treating PF.  With PF, the FHL will almost always become facilitated and we cannot cure the PF without releasing the FHL.  Rememembet that the FHL Originates at the Posterior surface of the distal 2/3 of the fibula and as well the interosseous membrane and associated fascia.  FHL inserts at the base of the distal phalanx on the plantar surface of the great toe.  Bascially the tendon of the FHL travels directly along side of the plantar fascia, which can and will directly alter the mechanics of the PF.  Don't forget to treat the FHL both where it travels posterior to the medial malleolus AND where it travels parallel to the PF.

Step 5- Go look at the knee and go look at the hip.  Take a look at their glutes first...  Do we have a weakness of gluteus medius causing a trendelunberg gait?  Is this gait abnormality causing extra stress on the PF?  Bingo, yes it is...  Do we have a restricted iliopsoas?  Is this restreicted iliopsoas?  A restricted iliopsoas migh now cause the hip to slightly internally rotate which will change the mechanics of the lower extremity and possibly increase pronation of the foot. (And thats just scratching the surface)

Step 5- Based on your movement pattern assessments- treat and fix the dysfunctional movement patterns.

Treat the mobility issues manually with your tool box and make sure once you have fixed the mobility issues you fix the stability issues.  Use the KISS principle (Keep It Simple Stupid).  Make sure you start simple and dont progress until they are ready.  Fix the core, fix the foundation and then move to the more complicated patterns.  And dont forget to treat in ALL planes of motion:  Frontal, Sagittal and Transverse Planes.

And that's my two cents on Plantar Fasciitis...  Remember, figure out WHY it's there in the first place.  If you just treat the foot, the issue will return. Promised.

1 comment:

  1. Good post Rick. I like how you stressed the FHL treatment. I think it very often gets overlooked. You should post a abstract on Physio Connection with a link, or post the whole article. I'd like to hear other PTs opinions.