Stubborn Plantar Fasciitis or Neural?!
Reference:Butler D. The sensitive nervous system, Niogroup Publications, Adelaid, Australia 2000
If a patient with plantar fasciitis does not respond to Physical Therapy intervention, it could be that the actual diagnosis of it was incorrect or only ?partially? correct.
Increased or abnormal sensitivity of neural tissue (specifically the tibial nerve) may be responsible for some ?plantar-fasciitis? symptoms.
To determine if the tibial nerve is a potential pain generator in ?plantar fasciitis?, do the following:
- In supine lying, dorsifex and evert the foot to bias the tibial nerve and note any symptom reproduction. (If symptoms are present it could be nerve, muscle or joint structures)
- Now evaluate the affected limb slowly as you would during a traditional straight leg raise (SLR) test. (Important note: You always test the opposite side first for means of comparison)
- Monitor the patient?s response with SLR. If symptoms are increased or reproduced with the hip flexion and there is a decrease in range of motion compared with the other side, it would support a diagnosis of tibial nerve involvement vs. plantar fasciitis.
- Adding neck flexion, or hip adduction can further help bias the nervous system and strengthen your hypothesis of altered neural tissue dynamics.
Submitted By:Alessandro Rosatelli, M.Phty., B.Sc.P.T.,Cred MDT
Posted on: January 25, 2002
Categories: Foot & Ankle
