Without even having to ask Frank how he found himself sitting in my office, he jumped right into his story telling me what had happened. At the beginning of spring time when we start becoming active outside again due to the warm weather upon us, Frank was motivated to bring his sports car out of the shed to take it for it’s first drive of the season. First before firing up his beauty, he had to put it in neutral to get it out of the shed so that the fumes wouldn’t fill the shed. So while he was at the back of the car and his bum on the trunk, he started pushing it while walking backwards. As he was up on his toes, pushing over 1200 lbs of metal out of his shed, he instantly felt a ripping feeling in the sulcus of his left foot. He immediately stopped pushing and hobbled around for a bit in severe pain. Frank said it was about 2 months after that he was able to tolerate the pain in his foot. It got to a point were there was pain first thing in the morning but then it would calm down. During his days, he could bear weight on his left foot but once he sat down for a while and got back up, the pain would be worse again. He decided to self diagnose his condition and went online to find out what this pain could be. He self diagnosed himself to have plantar fasciitis. Made sense to him, pain in the morning and pain when he stood up after sitting for long periods of time. But what stumped him was that his pain was in the sulcus of his toes and not in the heel or the belly of his plantar fascia band. So he went out anyways and got himself a pair of off-the-shelf birkenstock insoles. He said, within a weeks time, his pain in this left foot had calmed down to a tolerable point that he could walk on it. It wasn’t nearly as bad as it was first thing in the morning as it used to be.
Even though he was feeling great, he was still stumped and wanted to know why there was pain in the sulcus of his left toes and not in the plantar fascia area like how he read on the internet. That’s why he was sitting in front of me!
So I completed an assessment on him and this is what I found:
- Bilateral dropped metatarsal arch
- Bilateral tailors bunionette
- Bilateral neutral forefoot
- Bilateral neutral subtalar joint
- Normal ankle dorsi and plantar flexion
- Flexor digitorum longus tendon muscle test was performed. Pain was present when the FDL muscle was activated and then pressure was added.
- Bilateral neutral foot type
- Bilateral neutral rearfoot position
- Bilateral neutral forefoot
- Bilateral neutral midstance
- Initial contact with the ground was lateral heel strike
- Neutral midstance with resupination upon toe off
- Swing phase was normal
After completing my assessment, I had told Frank that no, he didn’t have plantar fasciitis. He had Flexor Digitorum Longus Tendonitis. The ripping sound that he felt when he was pushing his car was from the FDL muscle being activated while placing a large force of pressure on it that this little muscle group began to tear and rip on him. He felt the same symptoms as having plantar fasciitis because the plantar fascia band and the FDL muscle are both soft tissue strains in the plantar surface of the foot. First thing in the morning when he got out of bed, the tendon was cold and cramped. As it warmed up and was being used through the day, the pain was not prevalent and was noticed again when it wasn’t being used again. The off-the-shelf birkenstock insoles were providing the stability his foot needed to off load the FDL muscle to heal while weight bearing.
If it wasn’t for Frank’s traumatic accident to his left foot, I would see absolutely no reason to place Frank into a pair of orthotics. Biomechanically, Frank is properly lined up. He presents a textbook gait analysis. Due to that fact that he had place a pair of off-the-shelf birkenstock insoles on his feet that he saw results from but was looking for more of a custom support to fit his foot correctly did I then cast him for a pair of orthotics.