Foot Pain

K.M., a 41-year-old male attorney, presented with a 2.5 year history of right medial foot (arch) pain and tenderness. The pain was aggravated by jogging, which he was unable to do for 2 years. He was initially diagnosed by a podiatrist with “tendinitis” but he failed to respond to non-steroidal anti-inflammatory medication, plastic shoe inserts, an Aircast immobilizer, and three corticosteroid injections. He was able to exercise regularly but he was unable to jog for 2 years. Initially, there was also sharp pain at the inner aspect of the right foot for the first few minutes on awakening. The physical examination was significant for full and normal lumbar spine and hip range of motion. There was bilateral pes planus (flat feet), marked tenderness of the left navicular bone and the left posterior tibialis muscle motor point. Passive left ankle dorsiflexion and eversion (posterior tibialis “stretch” sign) caused pain posterior to medial malleolus.

He was diagnosed as a left posterior tibialis insertional tendinopathy and myofascial dysfunction of the posterior tibialis muscle. He was treated with a series of 3 once weekly sessions of dry needling of the posterior tibialis trigger point and instructed in a controlled standing 2-position calf stretching exercise. Within 5 weeks of initiating treatment he was able to begin a progressive alternating walking/jogging program and within 3 months he was jogging 3 miles, 3-4 time per week. All told he was treated with 6 sessions of trigger point treatments and therapeutic stretching exercise instruction. One year later, the medial foot pain recurred effectively treated with 2 trigger point injections. Follow-up by telephone 2 years later found the patient pain free and jogging 3 miles 3-4 times per week.

If leg or foot problems are affecting your ability to run or play sports, treatment with a myofascial approach may be the answer to your problem.

Also view our previous case reports:

Low Back Pain in a
Professional Seniors Tennis Player

Lumbar Disc Herniation in an Amateur Tennis Player