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When A Patient Has A Different Problem On Each Foot

I had a patient contact me previously regarding the left foot for which he received a diagnosis of tenosynovitis and plantar fasciitis. The same patient contacted me recently regarding a separate problem in the right foot.

As for the left foot, the patient increased his activity one day at the gym using an elliptical machine that put weight on his heels and was able to work out for 45 minutes at a good intensity. The next day, the tenosynovitis was much worse and the patient realized he had been curling his toes frequently, testing them to see if they were getting better.

The patient went back to doing a five-minute ice massage on the affected area every hour and an ice dipping protocol every day that consisted of a 10 second dip in ice water every 15 minutes for two hours. He said this protocol seemed to be helping. The patient wears a flat, firm shoe with orthotics (no splint). After waking up, the patient has noticed the foot is very tight with the plantar fasciitis so before getting out of bed, he massages the foot, especially the plantar ligament.

Handling re-flares successfully is a vital part to any rehabilitation. It is funny how rehabilitation is always presented as a linear progression but is really spiral in nature. Sometimes, we are closer to our goal and a minute later, we can be further away. The patient is mindfully walking and rehabbing toward the goal (the center in this case).

In regard to the patient’s right foot, he has plantar fasciitis there as well but for the last eight months, he has experienced a feeling of tight pressure right across the ball of the foot. There is some falling of the arch on X-ray. The patient has been icing and stretching the right foot. When the patient wears a Hoka One One on the right foot and the flat shoe on the left, he says both feet feel fine but he cannot walk like that.

The patient asked me if the tight pressure symptom across the right foot sounds like plantar fasciitis. I told him it could be a sesamoid problem. In this case, I would recommend a magnetic resonance image (MRI) on that area and trying the flatter New Balance 928, which has a rocker sole. 

The patient has been resting the left foot with the tenosynovitis and putting it up. He feels the resting has been causing the plantar fasciitis on the right foot to worsen. When patients are dealing with issues on both feet, it is easy to favor the "better" foot, which can cause problems. Also, a lot of foot problems, when they are more joint-related than muscular or fascia-related, can cause feelings of tightness with immobilization, even if it is from rest. In these cases, I would encourage the patient to try moving the big toe joint ten times up and down per hour to see if that helps.

Ideally, the patient would be seeking to create a 0-2 pain level for the right foot without upsetting the left foot. I would recommend an Anklizer II Low Profile Walker (Bird and Cronin) on the left foot and placing an EvenUp (EvenUp Corp.) over the right shoe for the next two weeks to calm things down. 

Editor’s note: This blog originally appeared at . It is reprinted with permission from the author.

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