Dorsiflexion
Plantar flexion
‘Dorsiplantar’ by Connexions, cnx.org. Licensed under Creative Commons Attribution 3.0
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Plantar flexion and dorsiflexion
tuberosity, three cuneiforms, cuboid and
bases of the second through to fourth
metatarsal bones. This makes the tibialis
posterior very important in the stability of
the lower leg, support of the medial arch,
and normal pronation.
Who is prone to suffer plantar
fasciitis?
Plantar fasciitis can be experienced by a
person displaying either lower- or higherarched feet. Clients with lower arches have
conditions resulting from too much motion,
whereas clients with higher arches have
conditions resulting from too little motion. In
both of these instances the tibialis posterior
is affected by inhibition. With the increased
motion experienced by the clients with lower
arches, the tibialis posterior is overused
through its support of the medial arch
during excess motion – in turn becoming
hypertonic and inhibited. In terms of the
higher-arched clients, the tibialis posterior is
continually engaged in contraction to assist
in supporting the medial arch height.
Assessment
In assessing a client presenting with pla ntar
fasciitis, the tibialis posterior needs to be
examined in order to, firstly, rule out tibialis
posterior tendinopathy and, secondly, gauge
the contribution of the tibialis posterior to the
client’s pain and biomechanical dysfunction.
The assessment of the tibialis posterior
should involve manual muscle testing and
palpation of (i.e. using the hands to examine)
the muscle and the tendon. A personal trainer
can undertake this assessment. To manual
muscle test, have the client supine with the
leg in lateral rotation and the foot inverted with
plantar flexion at the ankle joint. The practitioner
supports the leg above the ankle and applies
pressure on the medial plantar surface of the
foot in the direction of dorsiflexion of the ankle
and eversion of the foot. If the flexor hallucis
longus and flexor digitorum longus are being
substituted, the toes will be strongly flexed as
pressure is applied. A weakness will show in
decreased ability to invert the foot and plantar
flex the ankle.
The practitioner should palpate the entire
muscle and tendon. If there is sensitivity in
the area of insertion in the bottom of the
foot, the tendon behind the medial malleolus
and muscle belly should be palpated. The
insertion tenderness can often be mistaken
for plantar fasciitis. Releasing any adhesions
found within the muscle belly will decrease
the tenderness at the insertion.
If during the assessment the tibialis
posterior is found to be inhibited, the
muscle should be released and lengthened
through soft tissue work and stretching.
Strengthening exercises should then be
provided. These can include inversion
exercises, isometric, active, and resistance
band inversion.
The client should seek professional
advice before attempting any rehabilitation
exercises. A thorough examination of the
client’s biomechanics of the lower limb
should be undertaken by an allied health
professional to ascertain why the tibialis
posterior was inhibited initially. By doing so,
the health practitioner can determine what
appropriate action should be undertaken to
ensure the tibialis posterior is not inhibited.
For references read this article at
fitnessnetwork.com.au/resource-library
Sandra Steel, DC is the principal chiropractor at
Total Body Fusion n Morningside, QLD. She employs a
number of chiropractic techniques, dry needling, Active
Release Technique, Functional Movement Screening
and corrective exercises to achieve client functionality.
totalbodyfusion.com.au
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