plantar fasciitis/lower back pathology

[arifa]

HI there

Hope I can get some input from you guys, would really appreciate it.
Have 34 year old male patient presenting with pain around the right instep and numbness over lateral aspect of foot. No trauma. Started in Dec 2008.
Complains of lower back discomfort when his baby sleeps in the same bed as him.
He just feels lbp in the morning on waking then it goes away and it is only felt when baby in the same bed.
instep pain feels worse on waking in the morning, during the day there is slight discomfort.
On o/e good arches, all ankle movements painfree. tight plantar fascia, trigger points in calf.
Lumbar clear, no pain on movement and palpation, SLR, slump test.

Any idea what could be causing the numbness? Do some plantar fasciitis patients comlpain of numbness?

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[raymond]

There might be a couple of possibilities i would like to suggest that could be part of your differential diagnosis.
-Neuropraxia- If it took place somewhere around december, then, muscle weakness must have already set it. Guess what? by now, he would already have gotten problem with his stability in standing. Do a precise check on his nerve distribution and see whether it correlates with the lateral popliteal nerve distribution. Also palpate the head of fibula cause there's where the nerve coils and makes a superficial appearance. Perform the tinel sign along it's course.
-Musculoskeletal problem- Sometimes, due to nerve impingement/entrapment by soft tissue, the same signs may possibly be seen. So, soft tissue manipulation+myofacial release+ stretching of lateral structures of lateral leg may help. To activate those weak muscles again, make him do blancing exercises on the balance/wobble board or even on a pillow at home.... caution: he may fall.

His back pathology may be totally a separate case altogether or may even be a result of postural compensation with his impaired balance on one lower limb. Tell me if it works yeah!

[arifa]

Thanks raymond

I saw my patient today and he feels much better, pain has been relieved but he still complains of numbness/tingly sensation lateral aspect foot.
My last treatment entailed soft tissue work into calf, soleus, plantar fascia and i taped him at the end of session.
Today i did the same and worked on lateral structures with soft tissue and a/p's fib head. I will see him next tues and see how he does.
will update you

[linbin]

hi friend
hope you analysed the posture in general and specific to ankle.deviations in calcaneum,subtalar joint and forefoot associated with tibial torsion can stretch the tissues in the lateral aspect.hope you did a sural nerve bias SLR.
hypomobility of lower lumbar segments is ruled out???