Welcome to the Online Physio Forum.
Results 1 to 18 of 18

Hybrid View

  1. #1
    Forum Member Array
    Join Date
    Sep 2006
    Country
    Flag of Zimbabwe
    Current Location
    Somewhere in cyberspace
    Member Type
    Physiotherapist
    View Full Profile
    Posts
    25
    Thanks given to others
    1
    Thanked 0 Times in 0 Posts
    Rep Power
    40

    Re: Peroneal strain?

    Quote Originally Posted by Sports_Rx View Post
    Haven't tried taping - never taped peroneals before - is it like doing an ankle with 2 anchors, but higher up, and then diagonals with the foot dorsiflexed & everted? .
    Sorry I cant seem to visualise this. Yes there should be dorsiflexion and eversion. Like shin splints taping?


  2. #2
    Forum Member Array
    Join Date
    Aug 2008
    Country
    Flag of Australia
    Current Location
    Somewhere in cyberspace
    Member Type
    Physiotherapist
    View Full Profile
    Posts
    76
    Thanks given to others
    0
    Thanked 0 Times in 0 Posts
    Rep Power
    48

    Re: Peroneal strain?

    HI There,

    Apologies for delay in reply.
    Re tuning fork: it's a rudimentary test for bony irregularities and stress fractures as opposed to peri-osteal inflammation. You basically whack the tuning fork on a bench (NOT the patient) to get it vibrating then put the single tip end of the fork onto a bony prominence or as close to the "sore" spot as you can along the bone concerned. The fork causes a vibration in the bone... if there is a stress fracture you will be peeling your patient off the ceiling (it hurts!), if it's just periosteal inflammation it will be a tad uncomfy but nothing much. if there's no problem it just feels a bit tickly. good for testing 2nd MTP stress fracture points, and medial tibia too and far simpler than going for a full bone scan when treatment-wise, there would be no difference. but can't be done on bones which aren't so superficial.

    Ultrasound works on the same principle that it's vibration effect on the periosteal surface hurts if there is a bony fracture. still keep the US head moving tho... the aim is NOT to cause a periosteal burn!

    Re peroneal taping: Basically the principles of all taping apply to offload the muscle group so i would be placing the peroneals in a slightly shortened position (evert the foot slightly + or minus dorsiflexion depending on whether you suspect peroneus tertius to be involved as well), then tape along the line of the muscle to support it. i would also probably do a few perpendicular tape lines across the muscle belly as a means of force distribution. It's hard unless the patient is quite big, to do a full offload square/triangle around the sore part of the muscle but worth a try. remember don't use rigid tape for a full circumferential limb tape tho.

    I hope that makes sense.

    msk101


  3. #3
    Forum Member Array
    Join Date
    Feb 2008
    Country
    Flag of United Kingdom
    Current Location
    Somewhere in cyberspace
    Member Type
    Physiotherapist
    View Full Profile
    Posts
    30
    Thanks given to others
    0
    Thanked 1 Time in 1 Post
    Rep Power
    38

    Re: Peroneal strain?

    I know of a physio who's used a mobile phone on vibrate too


  4. #4
    Forum Member Array
    Join Date
    Sep 2006
    Country
    Flag of Zimbabwe
    Current Location
    Somewhere in cyberspace
    Member Type
    Physiotherapist
    View Full Profile
    Posts
    25
    Thanks given to others
    1
    Thanked 0 Times in 0 Posts
    Rep Power
    40

    Re: Peroneal strain?

    Cool! Now all I need is someone with a stress # to test it on...


  5. #5
    Forum Member Array
    Join Date
    Feb 2008
    Country
    Flag of United Kingdom
    Current Location
    Somewhere in cyberspace
    Member Type
    Physiotherapist
    View Full Profile
    Posts
    30
    Thanks given to others
    0
    Thanked 1 Time in 1 Post
    Rep Power
    38

    Re: Peroneal strain?

    Update: patient didn't hit the ceiling when I tested for stress # with ultrasound. Last treatment I did some more myofascial release and worked on the trigger points. TPs since gone.

    She said it was getting better (no running), has done cycling and swimming to maintain CV. Can walk upstairs on her toes and now do single leg calf raise pain-free. Single leg hopping is still painful and still feels 'weak' compared to other leg.

    This bit's interesting: she used a foam roller on the outer shank and experienced severe 'electric shock' pain in the peroneal area. Afterwards leg was sore again as though healing was put back.

    Could this have irritated the peroneal nerve? She reports soreness when sitting with legs folded underneath her (compressing the tissues), and can only stand light pressure on massaging the area.

    Any feedback / comments welcome


  6. #6
    Forum Member Array
    Join Date
    Mar 2007
    Country
    Flag of Australia
    Current Location
    Somewhere in cyberspace
    Member Type
    Physiotherapist
    View Full Profile
    Posts
    43
    Thanks given to others
    0
    Thanked 1 Time in 1 Post
    Rep Power
    41

    Re: Peroneal strain?

    Hi Sport-Rx,

    Sounds like it may be an irritation of the common peroneal or its branches - superficial likely given the symptoms reported. Either that or a superior tib-fib joint issue or both.

    You mentioned SLR was -ve and I'm assuming you added distal sensitizing components (DF/PF inv etc). Did you try adding hip adduction at the limit of hip flexion - I find this works quite well in picking up neural tension disorders in this area. You can also add accessory movements to the superior tib-fib and assess its affect on symptom response.

    What were the accessory movement of the superior tib-fib joint like?


  7. #7
    Forum Member Array
    Join Date
    Feb 2008
    Country
    Flag of United Kingdom
    Current Location
    Somewhere in cyberspace
    Member Type
    Physiotherapist
    View Full Profile
    Posts
    30
    Thanks given to others
    0
    Thanked 1 Time in 1 Post
    Rep Power
    38

    Re: Peroneal strain?

    Quote Originally Posted by Physio Dace View Post
    Hi Sport-Rx,

    Sounds like it may be an irritation of the common peroneal or its branches - superficial likely given the symptoms reported. Either that or a superior tib-fib joint issue or both.

    You mentioned SLR was -ve and I'm assuming you added distal sensitizing components (DF/PF inv etc). Did you try adding hip adduction at the limit of hip flexion - I find this works quite well in picking up neural tension disorders in this area. You can also add accessory movements to the superior tib-fib and assess its affect on symptom response.

    What were the accessory movement of the superior tib-fib joint like?
    Hi, thanks for your reply. Yes SLR with PF & Inv was more painful on the affected leg, pain in the area of her complaint. I checked sup tib fib - NS accessory mvt on posterior anterior pressure. Are there any other tests for this joint I should consider?

    Also both fib heads are tender on palpation (peroneal nerve again).

    Patient has improved, resting from running's helped obviously. There is very slight discomfort on repeated single leg hopping so I've advised no running yet.


  8. #8
    Forum Member Array
    Join Date
    Mar 2007
    Country
    Flag of Australia
    Current Location
    Somewhere in cyberspace
    Member Type
    Physiotherapist
    View Full Profile
    Posts
    43
    Thanks given to others
    0
    Thanked 1 Time in 1 Post
    Rep Power
    41

    Re: Peroneal strain?

    Hi,

    Most people are tender of the fibula head. Have you trialled neural mobilisations as a Rx?


  9. #9
    Forum Member Array
    Join Date
    Feb 2008
    Country
    Flag of United Kingdom
    Current Location
    Somewhere in cyberspace
    Member Type
    Physiotherapist
    View Full Profile
    Posts
    30
    Thanks given to others
    0
    Thanked 1 Time in 1 Post
    Rep Power
    38

    Re: Peroneal strain?

    Quote Originally Posted by Physio Dace View Post
    Hi,

    Most people are tender of the fibula head. Have you trialled neural mobilisations as a Rx?
    No I haven't... like a slump but sensitised for the peroneal nerve?

    Thanks for your input, much appreciated.


  10. #10
    Forum Member Array
    Join Date
    Mar 2011
    Country
    Flag of United States
    Current Location
    Illinois
    Member Type
    General Public
    View Full Profile
    Posts
    2
    Thanks given to others
    0
    Thanked 0 Times in 0 Posts
    Rep Power
    0

    Re: Peroneal strain?

    Hi Sports_Rx, I am experiencing many of the same symptoms you described in your patient. Could you tell me what the final diagnosis was and what worked in rehab and return to activity? Thanks.



 
Back to top