Abductor Hallucis Strain

 

INTRODUCTION:

The abductor hallucis muscle lies along the inside of the foot. It originates at the calcaneus bone at the back of the foot and inserts on the side of the big toe. It flexes and abducts the big toe and supports the medial (inside) arch of the foot.

MECHANISM OF INJURY:
The abductor hallucis is a significant, but seldom treated muscle located on the medial side of the foot.
It can be strained from:
• excessive standing postures,
• foot pronation
• Overload.
Trigger points in the abductor hallucis cause heel pain. Compression of the tibial nerve by the abductor hallucis can give aching in the foot as well as tingling and numbness. Tibial nerve compression by the abductor hallucis may also affect the health of the entire sciatic nerve, predisposing clients to sciatica and/or increasing the intensity of sciatica as well as increasing recovery time.

SIGNS AND SYMPTOMS:
 

• Pain along the medial longitudinal arch of the foot (pain along the inside arch of the foot)
• The athlete may over pronate.
• Pain and tenderness when pressing into the foot along the tendon of the abductor hallucis muscle.
• Trigger points in the abductor hallucis cause heel pain.
• Compression of the tibial nerve by the abductor hallucis can give aching in the foot as well as tingling and numbness.
• Tibial nerve compression by the abductor hallucis may also affect the health of the entire sciatic nerve, predisposing clients to sciatica and/or increasing the intensity of sciatica as well as increasing recovery time.
TREATMENT:
Dropping the Resting Tone of the Abductor Hallucis
Treatment of the Abductor Hallucis needs to take the underlying neural tissue into consideration.
For this reason I often begin with strumming the muscle just distal to it’s origin on the calcaneus. This allows me to drop the tone in the muscle without compressing the tibial nerve or its branches which are just a little more distal to this point.
Then I treat the muscle just past the course of the nerve with the same techniques. As the muscle begins to relax and drop its tone, then the big toe can be dorsiflexed to consolidate the drop in tone with a bit of stretching to the muscle.
Decompressing the Tibial and Plantar NervesAfter the tone has dropped in the abductor hallucis and a bit of length has been obtained in it, it is usually possible to decompress the tibial and plantar nerves. This can be done by stripping along their pathway, thereby loosening and lightening the myofascial roof that overlies them. This image at right with the dotted line shows the path that surgeons take when they decompress the tarsal tunnel with their scalpel.
Take the same path (gently!) with your finger or thumb as you release, soften, broaden and deepen the myofascial groove that the tibial and plantar nerves travel in through this region.
The general guideline is that the treatment techniques should not cause any increase in symptoms that lasts for more than a second after the technique is discontinued.If you cannot perform this manipulation without making symptoms worse or last for more than a second after you stop the technique you must do something less challenging! This might mean milking the fluid from around the nerve, applying cold hydrotherapy or treating related, but less irritable structures.
If this doesn’t work, then you will have to refer your client to a more experienced therapist or their physician.

Stripping and Stretching the Abductor Hallucis 
After the tibial nerve and its branches are decompressed; the abductor hallucis is available for stripping manipulations. These run from the origin on the calcaneus and flexor retinaculum all the way out to the insertion(s) on the base of the proximal phalange.

PHYSIOLINE’S SPECIALIZED PHYSIOTHERAPY HAS VITAL ROLE TO PLAY
At Physioline, all the members of the rehabilitation team work together so as to provide proper care and the therapy in order to:

• Pain relief
• Reduce swelling
• Strengthening of muscle
• Short foot exercises
• Prescription of orthoses

Visit Physioline for further Consultation and treatment