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Plantar intrinsic muscles and plantar fasciitis

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Dec 22, 2011.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Use of MRI for volume estimation of tibialis posterior and plantar intrinsic foot muscles in healthy and chronic plantar fasciitis limbs.
    Chang R, Kent-Braun JA, Hamill J.
    Clin Biomech (Bristol, Avon). 2011 Dec 12
  2. Craig Payne

    Craig Payne Moderator

    Chicken or egg? Did the weakness contribute to the plantar fasciitis or did the plantar fasciitis causes a disuse atrophy?
    Regardless of the chicken or egg, they appear to be weak and probably should be strengthened as part of the rehab.
  3. Dananberg

    Dananberg Active Member

    There is a significant subset of patients who seem to have abductor hallucis muscle spasm rather than plantar fasciitis. Manipulation of the cuboid seems to be the treatment of choice with spontaneous remission of symptoms immediately upon completion.

    On exam, the inferior heel pain is more in the muscle belly than in the fascia itself. Mechanically, with the rearfoot stabilized, there is an absence of lateral column (4th/5th rays) ability to dorsiflex.

    Cuboid manipulation video is available on youtube.

  4. Shane Toohey

    Shane Toohey Active Member

    For quite a few years I have been 'dry needling' whichever intrinsics relate to the location of the presenting pain according to their common referral patterns (area of the heel or arch) and if I can locate a painful locus in the muscle. I'll claim a very high success rate and follow up with cold spray and stretch, mobes and mechanical intereventions if indicated.

    Of particular note, regarding abductor hallucis, it often appears to be hypertrophied (and weak) perhaps oedematous and reduces in volume after needling. Paul Conneely has done a realtinme study on this with ultrasound measuring cross sectional area and found them to reduce significantly within 10 mins. So, for consideration, a muscle that becomes dysfunctional and weak may not necessarily reduce in volume but actually increase.
    Don't ask me why some would and others wouldn't but it seems common in abductor hallucis.

    Most commonly AH refers into the medial heel and QP into the central plantar heel, lower medial soleus refers to posterior half of plantar heel and borders and Peroneus tertius into the lateral heel. This is all part of the heresy around the idea of the plantar fascia not being the cause of the pain/dysfunction but becoming thickened as it takes on extra load as the intrinsics and Tib post fail to maintain function. There will be multiple factors leading to this development, including footwear, biomechanical dysfunction and jt dysfunction as outlined by Howard.

  5. stevewells

    stevewells Active Member

    Thanks for that Howard - Whilst testing the 4th and 5th how do you stabilise the rear-foot?

    Not to worry - just seen you tube clip
  6. timharmey

    timharmey Active Member

    Howard, I have seen the clinical effect of abductur hallucis contracture diminishing with cuboid mobilisation, and remember you giving an explanation as to how it works.Could you go thru it again, if I remember rightly you did not have a defintive explanation, I am not trying to put you on the spot ,I have a real interest ,it just would be useful to have a better idea of the mechanism of how it works.

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