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Case Study

Over the last 4-5 weeks, we have covered a number of running related topics on my blog. Injuries of barefoot vs shod runners, how cadence can affect hip muscle activation, fitting running shoes to foot shape does not decrease running injuries, and the last two weeks we discussed two different studies that using myofascial release on the calf musculature can decrease plantar fascia heel pain.

This blog post is going to be a case study on a client of mine. I will call him Hank. Hank is a big, muscular guy. He was really big into martial arts and MMA. I initially treated him last fall, in 2015, when he had a really bad lung infection. I ended doing a lot of chest physiotherapy, personally not my favorite thing to do. Getting my clients to try and cough up all the mucous from their lungs, however, this case it was needed.

Hank called me at the beginning of February in 2016 and asked about his foot pain. His foot pain was currently sore enough that he did not like to walk without his sandals, that had an orthotic molded into them. Walking over to his sandals first thing in the morning was very painful. The pain was just in front of the heel of his right foot. His left foot was also sore, only slightly.

After only a few treatments of intramuscular stimulation, IMS, as well as an exercise program to work on his intrinsic foot muscles he was able to start running. There was minimal pain before, during and after the run. Like it normally occurs, there were some days his right heel pain was worse and some days it was better. Image source

That all changed in late March. He was stepping up a curb when his daughter suddenly jumped on him. He was not expecting her to jump. His right forefoot was planted on the curb and he basically hyper dorsiflexed, brought the top of his right foot very close to his right shin, with his heel not touching the bottom. There was immediate right calf pain. The pain was in the gastrocnemius muscle bellies and went to the back of the knee. Since the incident, Hank noticed that his right heel pain had intensified.

Over the next few weeks, Hank’s calf would get better, then he would flare it up again by doing seemingly simple activities. For example, he would walk up the stairs, only landing on the ball of his foot or pivot and push off his right foot while at work and both activities, seemed to set him right back to square one. He did not understand why things so seemingly harmless would bother him so much.

During this entire time, he stated that his right plantar heel pain was more intense.

Each week, I would calm down his calf, via Intramuscular Stimulation, IMS, and soft tissue mobilization (massage) and each week he would come back with the calf all flared up again. We decided to try K-taping, his right calf. It worked like magic! Hank stated that with the tape on, it made him more aware of the injury/calf even when it was feeling better. He would not run up the stairs on the ball of his foot. Instead he would place more of his foot on the stair and use his entire foot to push him up. He and I were both very encouraged with the K-tape.

It took about a month for Hank’s calf to settle down with no little ‘tweeking’ it. Soon after that we started an eccentric loading program for his right calf strengthening. In addition, we start doing soft tissue work on his right calf. IMS performed on the right calf as well as the short flexor of the foot, similar spot to plantar fascia attachment on calcaneus, heel bone. In addition, manual therapy was added as Hank’s heel bone on the right foot seemed to be jammed up. This was evident when, I was mobilizing his right subtalar joint, in the heel, and he just let out a sigh and stated “you don’t know how good it feels to have that loosened up”. I thought I was going to have to get him a cigarette!!

Starting to integrate the knowledge of my last two blog posts, on soft tissue mobilization of the calf and its ability to decrease plantar fascia pain has been awesome. He would struggle through some of the sessions as the calf was quite painful but he felt we were on the right track. In addition, I did share with him the research and why I was doing what I was doing, working on his calf even though he did have a sore foot. Image source

Over the next couple of weeks, being treated once per week, his calf and foot pain have got less and less. He currently does not need to have his orthotic sandals near him at all times. Timeline = end of June 2016.

Hank started back running the first week of July. He is running on the treadmill at the gym for 30 minutes. He is doing this once or twice a week before his workout for a warm up. He is having minimal heel pain during and after the running. Some mornings after running he notices a slight increase in pain, which is completely normal.

He is currently being seen once, every 1-2 weeks. In the very near future, Hank and I will go for a little run together outside and I will get to do a visual assessment of his running mechanics and see if there are any suggestions on his technique.

If you have pain on the bottom of your foot and you would like a fresh pair of eyes on your issue, please contact New Leaf Physiotherapy. We would love to help you feel better.

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