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My naprapath suspects tendonitis of the flexor hallucis longus and flexor digitorum longus tendons

Posted by Julia M on 1/28/05 at 21:37 (168115)

I went to see a naprapath today to find out if tight calf muscles might be contributing to my PF. Some of you might remember I have mild heel pain, especially in my right foot, that my GP suspected was plantar fasciitis. She referrred me to a podiatrist, who did not physically examine my foot or take a detailed history, and after finding heel spurs on an X-ray, told me I had an inflamed bursa in my heel. He wanted to aspirate the bursa and fit me for orthotics. I said no, because that cure seemed worse than the problem itself! After researching this treatment on these boards and elsewhere, I decided to see another doctor. I put in a request for an appointment with another podiatry clinic and decided to see a naprapath to look at my calf muscles and see if they might be contributing to the problem.

The naprapath first examined my posture and gait. Here's what I learned that I didn't learn from the bad podiatrist who never examined my feet:

I have very flat feet.
I overpronate a LOT.
My toes turn outward more than is normal when I walk and stand (people have told me this for years, actually)
My knees also turn outwards more than normal (kind of like being knock-kneed but not quite). This contribues to my toed-out gait.

This puts a lot of strain on the foot, as we all know. It also may explain why I have had some pain on the outside of my hips when I first started running.

Initially she thought this might be a fat pad problem. She then felt my heel and arch to find out where the pain was. She also flexed and moved my feet around to see if those movements caused pain. We discovered that the pain is in a very specific spot in my heel, but I only feel it when there is a lot of pressure, and it is not quite in the typical heel spur/PF location. She continued to examine my foot, and found out that I don't have any pain at all in my arches, or with dorsiflexion. When pointed out that I hear popping noises when I rotate my ankle, she examined my ankles carefully and found some additional tender spots kind of on the sides of my ankle.

After looking everything over, she said that she thinks the tenderness in my heel and ankle may be due to tendonitis in the flexor hallucis longus and flexor digitorum longus tendons. Apparently, if you put a lot of the pressure on the spot where I have pain, it compresses them against the bone, so it would make sense that there would be pain there. She thinks that my pronation, toed-out gait, and flat feet have put a lot of stress on those tendons. She also checked my knees, and I was surprised when she put pressure kind of on the sides of my knees, I felt a LOT of pain, more pain than in my heel. She said that the spots she was pressing are the spots where those tendons attach to the knee joint.

She recommended that I wear arch supports, start paying attention to my gait and think about walking with my toes in a more normal position, and more on the outside of my foot instead of pronating so much. She wants me to look for shoes that help control pronation, and to ice my heel with a bottle as is recommeded for PF. She also recommended many of the stretches recommended here. She doesn't think I'll need a night splint.

She gave me an ultra sound treatment and did some massage of my feet and calves. Both felt pretty good. I may see her for one more treatment so that we can continue to work on my gait.

I will probably also see a new podiatrist. I found one at a clinic that I'm hoping to visit whose specialty is gait analysis, and I think I will try to get an appointment with him specifically.

I found an article online from the American Family Physician journal that says 'Tendonitis involving the peroneal tendons is a less common cause of heel pain but may be important when a patient localizes a meidal or lateral location of heel pain.' Doctors, have you ever seen a patient tendonitis of the flexor hallucis longus and flexor digitorum longus tendons?

Re: What is a Naprapath?

Pat on 1/29/05 at 06:45 (168118)

It sounds like you've have a complete workup and at least you know alot more than before you did. I'm just curious what exactly a Naprapath's job is and where do you find one? I just had EPF on 11/3 and I'm doing o.k. but I know that there is definitely something wrong with my gait etc (runs in the family and no one quite knows what it is). And due to some neurological problems I can't fully stretch out the calf muscles and I think if I could alot of my pain would be gone. Also, was this covered by insurance? The reason I'm asking is becaus I've never seen this particular specialty and I've been to more doctors (for a bunch of things)than I care to think about. Any informatin will be helpful.

Re: What is a Naprapath?

Julie on 1/29/05 at 08:49 (168123)

I wondered too, Pat, so I did a google search:

Naprapath practices include, but are not limited to, the treatment of contractures, muscle spasms,     inflammation, scar tissue formation, adhesions, lesions, laxity, hypotonicity, rigidity, structural imbalance, bruising,       contusions, muscular atrophy, and partial separation of connective tissue fibers.

The search turned up 4,000-odd hits, including directories, so you should be able to find one if you want ti.

Re: What is a Naprapath?

Julia M on 1/29/05 at 09:31 (168127)

Naprapaths specialize in treating the above with manipulation of the muscles, tendons, ligaments, etc. Many also focus on nutrition. They are different from chiropractors, who focus on the bones. Treatment will often consist of lots of stretching, massage, and occasionally some treatments like ultrasound or lasers. They never do invasive procedures like surgery. They will often refer patients to podiatrists and physical therapists for certain problems. Like podiatrists and dentists, they go through a specific doctoral program just for their specialty (their degree is DN, for Doctor of Naprapathy. If you are going to look for a naprapath, you should make sure they have a degree. Here in Chicago there is a big college of naprapathy, so there are a lot of them here.

My insurance plan covers 80% of my naprapath costs. I had a 90 minute assessment and treatment for $34. I think it varies a lot from plan to plan and doctor to doctor, and the specific treatment you are receiving.

Also, there are podiatrists who specialize in gait analysis, and I'll be there might even be some orthopedists who do, too. So don't limit yourself to a naprapath for gait analysis.

Re: What is a Naprapath?

Pat on 1/30/05 at 12:18 (168164)

Thanks - you know I had never heard of this but it seems like exactly what I need. I have a bunch of problems but since the EPF surgery I think everything just got so tight (calves, etc) and it's hard to do anything myself. Plus I do have some scar tissue and regidity and would just like to go for an initial appointment to see what's what.

Re: What is a Naprapath?

Pat on 1/30/05 at 12:20 (168165)

Right now I'm seeing the Podiatrist who did the EPF. I'm still having monthly followups for my progress (next one is this Tuesday) so I'm going to ask him about the Gait Analysis and the Naprapah and go from there. I know I have problems with my Gait (had tons of MRI's to see if it was something else) and would just like someone to analyze it. I would have to check with my insurance. They wouldn't pay for ESWT so I elected for the EPF surgery and so far I'm doing o.k. but it's a long healing process. Thanks for the information