Dislocating Toe?

[RMTJosh]

alright
I have a client I just started seeing today. His complaint was his low back. Through his assessment and general probing I found out he is having a foot problem.
In the past he has suffered from plantar fasciitis and hammer toe. Recently, the end of August, his toe started to dislocate and it happens on a frequent basis. So much so that he has been put on light duties at work and has ceased all exercise. Including running, soccer and general fitness.

He has seen a podiatrist and tried orthotics with no luck.
Any ideas on what may be causing the problem, or areas to look into. I will be going back to reassess the plantar fascia issue, and I'm sure with his gait compensation there will be some issues with everything from his ankle up.

Any input and ideas would be great. Thanks PhysioForum

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[ginger]

"plantar fasciitis"= sciatic irritation= lumbar pain =L5S1 protective behaviour leading to referred events in a sciatic distribution=limping=further lumbar hypomobility=exasperation=visit you.
Thoroughly mobilise L5S1 till normal tone and a non protected state of mobility is restored there . May need a stetch to his sciatic nerve. When you say the term "plantar fasciitis", think , referred pain. Ditto for hallux pain , certainly with what you have described in this case.

[RMTJosh]

well its definately not a referred pain
his toe actually dislocates
i'll have a look into L5 S1 to see if there is any imbalance or issues with mobility.
Thanks ginger

[gcoe]

Exactly which toe joint dislocates and in which direction? How does this relate (if it does) to the hammer toe deformity? I presume it is the MTP dislocating in a volar direction?

It would be definitely worth looking at a movement impairment syndrome point of view. So have a good look at the length and weakness of the intrinsic foot muscles (likely to be weak) the extensor digitorum, flexor digitorum profundis and flexor digitorum superficialis (or the equivalent in the big toe if it is the big toe). Hammer toe is often due to weakness of the intrinsics (inability to flex the mtp while extending the ip joints) shortening or hypertrophy of the FDS muscle or the equivalent in the big toe) You could try a combination of muscle balance correction with splinting for several weeks.

If he is having all these musculoskeletal problems it may be worthwhile looking at movement impairments above the foot as well - a la Shirley Sahrmann

However to be honest by the time the ligaments have become so stretched that the toe dislocates - and there may now be other articular damage, it might be conservative measures isn't going to work. Things may have progressed too far in which case it is off to see the orthopaedic surgeon.

[RMTJosh]

Thanks for the input
to clarify in case anyone else has ideas, it is the index toe at the MTP joint of his left foot.
The plantar fasciitis came first, then hammer toe, and now he has started to get low back pain.
The back pain brought him in for Massage Therapy but the problem in the feet seems to be the starting point for the rest of the pain.

[ginger]

"The back pain brought him in for Massage Therapy but the problem in the feet seems to be the starting point for the rest of the pain. "

\Most unlikely, cart before the horse here, what you are observing are salient features of the the natural history of lumbar protective behaviour, where referred events are the early alert the brain provides to a state in the lumbar spine. Mobilise the L5S1 joint on the ipsilateral side till protective tone there ( and pain associated with mobs ) is normalised. At this point recheck for painfull events and or noise in the foot.
cheers