Case Presentation: 55 year old female presents chronic pain to left posterior heel for the past 5 years
55-year-old female, presents with chronic pain to the left posterior heel for the past five years. The patient has seen several orthopaedists, podiatrists and physical therapists, but the pain persists, causing a limitation in daily activities and exercise. Patient states that the pain is greatest in the morning, decreases slightly during the day and then increases again at the end of the day. There’s a sharp pain and it’s rated a six out of 10, no associated tingling or numbness. The patient does not recall an acute injury and it’s been a gradual increase over the past five years.
Dr. Mark Wade presents his thoughts on this case presentation.
I would definitely be checking the pelvic alignment as we’ve mentioned several times and as a Dr. Brandon said, I would go even further up and I’d go into the lumbar spine. Any type of hyperkyphosis of that lumbar or pelvic superiority is gonna alter those gait patterns, causing an increased wear and tear on the joints. So not always but often the affected or symptomatic joint is the compensation. So I would expect to find some dysfunction, in this case presentation of the right pelvis and ilium as well as the sacrum. Most likely we’d be seeing some decreased or weak glutes that are causing part of that gait dysfunction. I’d like to see the patient’s gait, as we’ve all already mentioned, it’s important to obtain as much objective data as possible. Jeff and Steven both mentioned this, as this would give away some immediate information and if there was any issues related to that.
However, it was noted that there is pes planovalgus on stance with increased knee valgus on single leg squat. So with that, I’m gonna assume I would also find some glute dysfunction. First thing I would do to correct, is correct the gait. We need to activate the glute max and med. We can use exercise specific activation, such as a side lying clam exercise with resistance. I would also use the CPC protocol or manual therapy to ensure the pelvis is correct alignment without any restrictions, ensuring that the SI motion is intact and functioning properly. If the sacrum is not moving correctly, that’s gonna offset the opposite ilium, affecting the entire lower limb.
Lastly, we already know that the ankle has decreased mobility and some hypertrophic action going on. So I would also check the calf for any trigger points in the surrounding tissues, maybe doing some ART or trap and release, but definitely would use some posture tape using K tape to help take… To inhibit those facilitated hypertonic muscles, as well as to add some comfort to the Achilles and help with that foot positioning.
I would use negative tension taping, though, such as superior proprioceptive rehabilitation tape, SPRT, with zero tape tension to get that.
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Dr. Mark Wade D.C, PhD, CPE,
Dr. Mark Wade is the founder of the American Posture Institute, creator of the Certified Posture Expert program, board member of the International Posture Association and President of the Council On Human Function. Dr. Mark is considered one of the most “Certified” Posture Experts on the Planet, having obtained more than 45 certifications in posture, neurology, and human function, including a PhD in Public Health. Clinically Dr. Wade has worked with professional athletes and sports teams in every major sports arena and has served as the official Posture Practitioner for the 4 Time National Champions – Parma Panthers. He has become widely known for his ability to help individual athletes and teams perform at their maximum potential having achieved a total of 7 national championships.