Hip to Big Toe!!!

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Hi all, I am a Sports Rehab grad seeking sound advice from you low limb biomechanic geeks! I'll keep this as concise and relevant as possible!

I have a patient who presented complaining of left anterior hip pain of 2/12 in duration. Questioning revealed a long standing issue with 'achilles tendonitis' (5-10yrs) aggravated by running. Examination showed a postive Thomas test for mobility of psoas, iliacus & TFL (rec fem ok), reduced dorsiflexion and hallux limitus (practically rigidus) on the left. His tib post muscle was like a rope on palpation and this was the source of pain for his 'achilles tendonitis'. Further quizzing found that he used (15yrs ago) to suffer from pain in his left big toe but not anymore. On gait observation I notice he supinates at midstance and can see a firing of the lat soleus and tib post directly preceding this.
I prescribed 1st ray mobs, plantar fascia t-balling, dorsi mobs, tib post manual Rx and hip mobs.
The hip is better but the 1st Ray is as stiff, the plantar fascia loosens but tightens again as does his tib post which I am sending him to laser surgery for.
i believe his issue is his avoidance of his 1st Ray and the subseqent affect this has, he has been to a podiatrist in the past but was given a first ray cut out. I am sending to a podiatrist again and would like to accompany my letter of referral with some form of possible reccomendation.
What would you reccomend to prevent the tib post from murdering itself trying to lift him off the first ray (assuming my dx is accurate)?

I would greatly appreciate the considered opinions from the illuminated minds that roam this forum, obviously if you have any questions please fire them out to me.

Thanking you in advance,

Danny

 

Welcome Danny, fnatastic post but I suggest you go to biomechanics forum and the top of the page start a NEW THREAD. Copy and past and you will quickly have many ideas sent to you.

OT's would need to alter as his pathology alters, First ray cut out no longer appropriate.

Warm regards