Sometimes it is easy and straight forward.
HISTORY: A 56 YO 200 # male construction worker presents with pain at the bottom of his right foot, worse in the am, getting better as the day goes on till midday, then getting worse again. Better with rest and ice. More supportive shoes and a heel gel pad offer him some relief. Past history of plantar fascitis.
OBJECTIVE: Tenderness at medial calcaneal facet right side; tenderness also in the arch and over the flexor hallucis longus tendon and short flexors of the toes. Ankle dorsiflexion is less than 5 degrees on the right, and 15 on the left. Hip extension was less than 10 degrees bilaterally. He has mild bi-lat. external tibial torsion.
Gait evaluation reveled an increased progression angle right greater than left. Very limited ankle dorsiflexion noted bi-lat (decreased ankle rocker).
There is weakness of the short flexors (FDB) and long extensors (EDL) of the toes on the right. Poor endurance of the intrinsic musculature of the arch as well as interossei musculature during standing arch test.
ASSESSMENT: From history and exam, plantar fascitis.
PLAN: He was given the following exercises: lift/spread/reach, the one leg balancing, shuffle walks and toes up walking. These were filmed via ipad and sent to him. We are going to build him a medium heel cup, full length orthotic made out of acrylic. We will see him again later this week. We will do some symptomatic treatment utilizing manual stimulation techniques, pulsed ultrasound and additional exercises aimed at improving dorsiflexion as well as hip extension.