CASE STUDY:  Right 1st toe pain in a runner

Subjective:
female runner presents with pain in her right 1st metatarsal-phalangeal joint. Minimal pain with running but increases after she has stopped. Her pain is worse with distances. She also has pain with squatting or wearing heels where where toe is placed into extension.

Objective:
Inguinal hernia scar on right (was done when she was 5)
right ilium inferior and medially rotated
right midfoot rigid with limited supination/pronation
right 1st MTP hypermobile into extension

Assessment:
Inguinal hernia repair tension the Deep Anterior Line (Myers, T. Anatomy Trains) comprised of the iliacus, adductors and posterior tibialis. The line ends at the medial longitudinal arch where it was causing supination of the arch and locking of the joints of the midfoot. This was also creating deviations of the right ilium with subsequent sacroiliac joint dysfunction.

Plan:
Instrument assisted soft tissue mobilization to inguinal hernia repair scar and posterior tibialis. Muscle energy techniques to correct the right SI joint. Joint mobilizations to right medial longitudinal arch.

Results:
Patient was able to squat/knee without pain after treatment.

(NOTE: image is not of actual patient but more for reference of typical inguinal hernia incisions)