Thursday Thoughts: What Do You Think I Did With This Foot Pain Patient? | Modern Manual Therapy Blog

Thursday Thoughts: What Do You Think I Did With This Foot Pain Patient?

I have not had a chance to follow up with the triathlete, but he is doing well. This time I thought I would post a few more gait analysis videos, this time of a patient presenting with right lateral foot pain.

Gait Video analysis prior and after Tx

What do you see?

Subjective: Subjective: Onset 1 month ago of R lateral foot pain from new sneakers. 3 Miles/day, 4-5x week, noticed pain after 2 weeks.  Initially switched due to right lateral hip pain, resolved on own. No new history otherwise. Previous history of knee pain and coccyx pain both resolved with PT at our facility.

Worse: in the morning, walking after sitting > 1 hour, while running.

5-6/10, intermittent, has been unchanging since onset.


Findings from different systems

MSR Left FN Right DN
breakout hip IR active and passive DN on right, tibial IR DN on right
SLS Left FN Right DN

SGIS Left FN Right DN min loss

L adductor drop positive, L Thomas test positive

Gait prior to treatment with 5-6/10 pain in right lateral foot

Neurodynamics: lower limb neurodynamic test bias DP with peroneal nerve bias on the right, reproducing her complaints

Gait after 20 minutes of treatment (various techniques) 1/10 pain

What did I do? Your choices are

1) SGIS to the right, neurodynamic sliders to peroneal nerve, followed by RockTape to peroneal pattern
  • to restore lumbar loading on involved side
  • to modulate peroneal nerve pain on right side
  • taping to continue Sx modulation of peripheral nerve container
  • instruction on SGIS and neurodynamic tensioners for HEP
2) QL Release on right, hold relax to left hip adductors with hold relax to right hip flexors, IASTM to peroneal patterns, followed by neurodynamic peroneal sliders
  • Hold relax - to restore neutrality and ability to stance phase on left, helping to inhibit L AIC Pattern
  • IASTM to peroneal patterns to modulate pain during neurodynamic tensioner
  • instructions on 90-90 hip shift with left hamstring and adductor activation and neurodynamic tensioner for peroneal nerve for HEP
Both are plausible? Which do you think I went for without hesitation? There is a reason why I'll go over next week!

Keeping it Eclectic...


  1. Hi Dr. E, I think you went for the second one and I will try to explain why: +ve neurodynamic riproducing her complaint is the more important thing - if SGIS R had reproduced her complaint, that could have been the first thing. But working on QL R could be interpreted as a kind of different way of working SGIS, because the Lx area needed some job anyway. Then you use the PIR for the adductors and you may retested everything. Things about the stance were better but no effect or little effect on the neurodynamic complaint. So after that for sure you worked on neurodynamics - this Tx is present in both solutions :-) I have just started reading your wonderful blog - I do share your rehab eclectic vision - and even I have not read lots of posts I think - hope so - I can understand a little of your working style. So because of the neurodynamics and because it was DP I think you first started working the container with IASTM. Once "remodulated" the tissue downthere, you went with tensioner and not sliders because you look for reload - same concept as for the retraction plus SB for Cx I guess. Only a doubt: because I have read you prefer work on DP first, I am not sure you started with Ql and adductors first, actually. Anyway, looking from outside and knowing the solutions :-) I think I would have tried SGIS anyway and then checked if QL tone was changed. And I think I would have put a Tape anyway because we do love taping in Italy - even just for a placebo. Thank you for the case and hope something is right in my clinical reasoning. If opposite occurred, a nice lesson I will learn.

  2. What a dump!...I did not see the date...sorry and thanks anyway, I have just read the part II