Who knew the big toe was so important!

Hey guys…2 down, 2 to go!! I hope you all had an enjoyable and successful second prac and are ready for the home stretch J

I’m going to write about an interesting patient I had during my musculo prac. This patient had experienced a partial Achilles rupture in late September. She was in a BK POP for 9/52, a walking cast for 1/52, followed by using a heel raise for approx. 2 months. She presented to the clinic in early Nov. with 4/10 heel pain after about 30min walking, decreased global ROM, mainly DF and big toe extension, decreased strength of PF’s, abN gait pattern and swelling. Following 2 months of treatment, consisting of PAMS, physiological movements, STM, A/AROM exercises, and theraband strengthening exercises the patient had regained full ankle ROM in NWBing positions, had an improving gait pattern, only hyperextension of knee remaining, and only minimal swelling. Her heel pain, strength and extension of her big toe were the main problems when I began treatment with her.

Determining the cause of her heel pain took a little bit of assessment, but I eventually determined that it was the cause of shortened, tight FHL and the lack of extension of her big toe. The lack of ROM was altering her gait pattern, thus affecting the load acceptance and transfer during walking. I found this extremely interesting and never would have considered this without the guidance of my supervisor. Simply by improving her extension, with AP glide of the 1st MTPJ at end range ext., physiological extension, and STM of the deep posterior compartment (FHL), her gait improved, decreasing her knee hyperextension and her heel pain improved. Over the week following this patient’s heel pain decreased to 2/10 and it took an hour to come on (vs. ½ hr).

Just thought you all may find this interesting as well, it may help if you ever have a patient with unexplained heel pain. Take a look at the patients toe ROM, it’s more important than I previously realized.