I recently had a 32 year old female arrive to my clinic under Direct Access (without a physician referral) with right foot pain. The pain started about 3-4 weeks ago from insidious onset and seeking my assistance as the pain is not improving. The location of the symptoms are circled below:
Her main deficits are pain with weight-bearing, especially walking. She has not been able to work-out (a recreational walker/runner but not avid) and difficulty negotiating the classroom as she is a school teacher. She has tried wearing more tennis shoes (vs flip-flops) with some improvement but not enough where she thinks it will get better on her own. She has not tried any exercises, self-modalities or self-medication from OTC drugs. Medical history is unremarkable besides a 5th ray fracture 5 to 6 yrs ago treated conservatively through wearing a boot but no physical therapy. She fully recovered.
Clinical findings are below:
1. Patient has an abnormal gait pattern with altered weight acceptance in stance phase on right side, especially mid to terminal stance. She has most pain with toe-off and really avoids this resulting in early heel rise. Symptoms come on immediately and not necessarily get any better as she walks more (she also claims to walk differently now to avoid the pain).
2. Patient has full, pain-free ROM of the ankle and foot.
3. Manual muscle testing unremarkable.
4. Reproduction of concordant symptoms with mild to moderate palpation at location circled in picture above.
What do you think is the diagnosis? How would you go about treating this individual?