Plantar Fasciitis and Myofascial pain

Plantar Fasciitis and Myofascial pain Blog  Plantar Fasciitis Myofascial Pain

Discomfort in the heel of the foot is a common injury that many people suffer from. Often called plantar fasciitis, the heel of a person’s foot is very sensitive to developing sensitive and painfully inflamed areas that lead to myofascial pain.

One of the principal causes of myofascial pain is damage to the tibialis posterior tendon. Although these injuries are often repaired surgically, relatively little attention has been given to the study of plantar fasciitis in its early stages. Scientists have thus developed a special test to identify this type of foot pain, a measure of the tightness of the posterior myofascial tibialis (TPMT). The tibialis posterior tendon follows three distinct stages. In the first part, the foot pain is usually so mild that a person doesn’t even feel it, describing it only as a dull discomfort in the ankle. A careful examiner will discover some minor swelling and tenderness in the heel after asking the patient to stand and lift their healthy foot off of the ground and then try to curl upwards their toes on the other foot.

In the second stage, the injury has become more severe, usually as a result of long-term damage. There is now pain even when the person is not standing, and the swelling and tenderness is easily visible. Patients will begin to complain of myofascial pain in the mornings especially, noting that the pain increases during the day. In the second stage, most patients cannot report a specific injury or activity that caused the plantar fasciitis. A medical professional, when examining someone with the second stage of this injury, will note that the patient has trouble completing a normal range of motion for their foot.

Stage three is when the tendon has been completely ruptured, and the patient complains of constant plantar fasciitis pain. A doctor can determine that the patient has arrived at stage three when the person stands on their injured foot, and their toes curl up in an unnatural way that makes it seem as though they have “too many” toes. X-ray examination will reveal that the patient’s foot has been severely flattened.

Nonsurgical Techniques for Managing Tibialis Posterior
Dysfunction

Using specific techniques, doctors have been able to treat heel pain up to 95% of the time without resorting to surgery. Many doctors will administer pain medications, but the primary treatment is to teach the patient specific stretching and strengthening exercises. A regimented course of physical therapy to stretch and loosen up the tendon in the heel will work towards lessening or eliminating pain in that area of the body.

Even after the pain has been eradicated, it is important for athletes and other physically active people to learn how to train correctly, including a period of warm-up and stretching exercises into their routine. It is also critical to maintain an even weight load on each foot, which includes wearing a pair of properly balanced and supportive shoes. By carefully observing the motion and situation of the foot, a patient with heel pain can learn to identify common stresses that they are placing on their feet, and develop techniques for achieving a more balanced gait and motion. Other non-surgical techniques useful for reducing heel pain include applying heat and/or cryotherapy (cold) applications. Many patients who suffer from heel pain can greatly benefit when ice or supercooled sprays are applied to the area.

Heel pain is generally caused when small groups of muscles get overstretched or abused and start to develop tension in small, specific areas of the heel. Over time, the damage to these points causes more tension in the foot muscles, which makes the problem worse. Furthermore, by avoiding certain muscle groups due to pain, these muscle groups will begin to wither and become weak.

In some cases, it may be necessary to be measured for orthopedic shoes. These special shoes will provide extra support and balance for the affected area, helping to better distribute the load on the feet, allowing the muscles to unwind and become more flexible, which will lead to a reduction or elimination of discomfort.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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