Monday, July 13, 2009
Plantar Fasciitis or Nerve Entrapment
If you have ever experienced the pain of plantar fasciitis, you know how a frustrating injury it can be. Every step becomes a small stabbing knife in the arch of the foot. Waking up in the morning and putting your weight on the feet can be such a daunting task that it makes you think of reasons to stay in bed.
True plantar fasciitis involves the inflammation of the plantar fascia. It's a thick structure that aids in the support of the foots arch, when it becomes inflamed there will be pain every time it tenses up.
Nerve involvement should always be considered as it may save you valuable time and frustration with conventional treatment protocols of rest, ice and NSAIDS. Two options should be considered. On the medial side, the tibial nerve can become entrapt about two centimeters posterior to the medial malleolus. Once past the flexor retinaculum the tibial nerve splits into the medial and lateral plantar nerves. This is the 2nd spot that can be entrapt. The medial plantar nerve can be entrapt where it runs deep to the abductor hallucis muscle.
A quick way for the clinician to check is to do the straight leg raise test and involve dorsiflexion and then eversion. If there is a nerve component to the fasciitis, this will usually create more discomfort in the arch. Test this on yourself, if this invokes a response, get some quality tissue work done on the stated areas. It is painful, but worth it.