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abductor hallucis pain (attachment to the calcaneus)

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Michele Palazzesi, Sep 13, 2011.

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    Hi all,
    In this condition is controindicated the Medial Heel Skive?


    Michele Palazzesi
  2. efuller

    efuller MVP

    The abductor hallucis muscle has esentially the same attachments as the medial slip of the plantar fascia and serves a similar function. The distance between the base of the hallux and the calcaneus increases with pronation of the STJ. So, if you slow the velocity of pronation you could decrease the strain on the abductor hallus attachment to the calcaneus. So, this is a reason to use the medial heel skive in this case.

    The attachment of the abductor hallucis is very close, anatomically, to the place where you would increase force from a medial heel skive. It is concievable that increased force on the plantar medial calcaneus could increase pain at the attachment site of abductor hallucis. In my opinion, you could fashion a medial heel skvie device that does not incrase pressure on the medial calcaneus. I would have no problem trying the device with a medial heel skive and then altering it, if there was an increase in pain.

  3. Michele:

    As Eric stated, the medial heel skive, when added to a properly constructed custom foot orthosis, should help relieve the pain from abductor hallucis muscle strain, not exacerbate it (Kirby KA: The medial heel skive technique: improving pronation control in foot orthoses. JAPMA, 82: 177-188, 1992).
  4. musmed

    musmed Active Member

    Dear Michael

    It is extremely common for the abd hall to have trigger points in the muscle.
    If you care to push on the mid belly (between the med. malleoli and navicular) and it is painful and or the muscle starts to fibrillate (unique to tis muscle) there is a trigger point in the muscle
    Just stick a 25G needle in as deep as possible and then stretch the muscle.
    Most times you will eliit a major twitch response and their pain will be gone immediately
    Sometimes the quda plantae has a trigger point present as well. This must be treated as well.
    Try it and you will be suprised.
    Paul Conneely
  5. pod29

    pod29 Active Member

    Hi Paul

    Thanks for your input.

    I was hoping you could elaborate on the fibrilation in this muscle. What exactly do you mean by fibrilation and why do you think it occurs?


  6. musmed

    musmed Active Member

    Dear Luke
    Thanks for the question
    I spent nearly 3 years on and off looking at this muscle in people who had the classic history of PF
    The muscle in 60% was fibrillating that is fine twitching at rest. Some had very obvious twitching while others had a very fine fibrillation that was only seen on ultrasound.

    The other fascination was that dysfunctional abd hall muscles change colour from a greyish normal colour on U/S to black
    Dry needling this muscle caused it to change colour towards normal in 10 minutes and in that time there was an average of 12.8% reduction in cross sectional area
    At 6-8 weeks follow up the muscle no longer twitched, their heel pain had gone, most at the time of needling and the muscle had reduced a further 2.4% in cross sectional area at the medial malleoli.
    I was unable to see these changes in any other foot muscle of lower limb muscles

    I wished I knew what caused it to twitch. When showing my patients I just told them it was a 'sick puppy'. Never had an arguement about that

    You can see this on my website
    Paul Conneely

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