A 35-year-old female distance runner and chef presented with left-sided heel pain and a diagnosis of plantar fasciitis. Her symptoms were worse in the morning and after standing all day at work. She had tried many different manual therapies and used specially made orthotics for running. She had been prescribed a night splint to keep her ankle at 90˚ while sleeping.
Evaluation, clinical reasoning & treatment strategizing
During postural analysis we found that the arch on the left side flattened more on weight-bearing. She also had functional hallux limitus (reduced big toe extension) on the left side. This inability to extend the big toe can create more stretch tension on the plantar fascial at its proximal attachment site on the calcaneus (heel bone).
NMT treatment first focused on lengthening the calf muscles (gastrocnemius and soleus) with moderate friction treatment at the tendon attachment on the heel. Trigger points were also deactivated. We then treated the intrinsic foot muscles, with attention given to those attaching to the big toe. The quadratus plantae muscle, the interossei and abductor hallucis were also thoroughly examined. Icing and eccentric calf stretching exercises were recommended as homecare activities. She continued to sleep with the night brace. As inflammation decreased we were able to work deeper on the foot.
Outcome and follow-up
Eight NMT sessions helped to alleviate symptoms. Specific Neuromuscular Therapy homecare activities helped rebuild her medial arch and gain extension at the big toe.