Recent Con-Ed and Trainings:
• Leslianne Yen MD: Hydrodissection for Peripheral Nerve Entrapment
• Sarah Wyant PT: Lumbar Disc Management
• Elisa Owens PT: Ankle Ligament Manual Stress Testing
- Mitch Owens PT: Differential Diagnosis and Manual Assessment for Sacroiliac Joint Dysfunction.
- Linda Joy Lee PT, PhD: Connect Therapy in Vancouver, B.C.
- Mitch Owens PT: Shoulder Examination and Treatment
Clinically Focused: The Union PT Newsletter
Evidence Update on Heel Pain
Foot intrinsic muscle weakness and heel pain:
How to determine if foot intrinsic weakness is contributing to heel pain:
Plantar heel pain or plantar fasciitis is a common patient complaint and one of the most common conditions treated by physicians, podiatrists, and physical therapists with an estimated annual patient visit count of 1 million. Conventional conservative treatments include stretching of the calf and plantar fascia, splinting, manual therapy, taping, and modification of foot wear. Many patients respond well to this approach, but will often have recurrence of pain.
The authors of this article highlight the presence of measurable plantar flexor strength deficits and toe flexor strength deficits in the presence of plantar fasciitis when compared to controls. The authors propose a measure of toe flexor strength labeled the “modified paper grip test” that is more objective and less productive of patient symptoms than other previously studied measures. For this test, the patient is asked to press a standard business card firmly against the ground with the great toe and then the lesser toes as the practitioner attempts to slide the card out while applying just enough force to a digital pinch force gauge to move the card. This paper grip test has been previously detailed as a pass or fail test, but with the addition of a digital pinch force gauge quantifiable strength measures are added.
Strengthening of the toe flexors with exercises such as the towel scrunch, toe manipulation of marbles, and resistance band training for the foot intrinsic should be considered to address weakness that is more objectively measured with the proposed tests.
Insights Regarding Ligamentous Laxity in the Ankle:
An ankle sprain, regardless of grade, can decrease structural support and neuromuscular control of the ankle, which in turn increases the risk of recurrent sprain. Supportive taping and bracing of the ankle can be helpful in unloading the injured structures while there still exists a need for proprioceptive training to return normal neuromuscular control to the joint.
Post injury stiffness through the talocrural joint will often occur, requiring mobilization efforts to restore proper glide to the joint. This stiffness can drive dysfunction up the kinetic chain, inhibiting uphill walking and squatting while producing anterior ankle pain secondary to impingement. Conversely, ligamentous laxity at the tib fib joint can also produce dysfunction at the knee and hip by inhibiting gluteus medius function producing increased valgus moments at the knee. One way that this can be addressed is with stabilization through the tib fib joint with circumferential taping with a period of rest before closed chain training is initiated.
What’s Coming Up For Union Physical Therapy
The entire clinical staff will be attending training on the management of TMJ disorders in October. We hope to become a center of excellence in managing these issues.
Published in JOSPT August 2016
McClinton S, Collazo C, Vincent E, Vardaxis V. “Impaired Foot Plantar Flexor Muscle Performance in Individuals with Plantar Heel Pain and Association with Foot Orthosis Use”
Clinically Oriented ● Volume 1 ● Union Physical Therapy ● 206.588.0855