Thursday Thoughts: What Do You Think I Did With This Foot Pain Patient? | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

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...

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