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
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.
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.
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.
Thanks
Tim