Case Study Plantar Fascia Tear

Vinny Comiskey Who: 25-year-old female Field Hockey player with Plantar Fascia MA, ATC, CSCS Tear, Sesamoid Fracture, and Nerve Entrapment.

What: Patient with chronic plantar fasciitis elected to undergo Plantar Fasciotomy, Great Toe Sesamoid Excision, and Nerve Release.

Why: The Anti-Gravity Treadmill™ enabled the athlete to maintain fitness, manage gait, and progressively increase impact on the extremity post-operatively.

Introduction 25 y/o female Field Hockey with Plantar Fascia tear, sesamoid fx and entrapped nerve. Sport is played on artificial turf, requires constant running and frequent change of direction. 1. Athlete suffered from chronic fasciitis for 6 months. Diagnostic imaging confirmed diagnosis of plantar facia tear with nerve entrapment 2. Athlete elected to undergo plantar facia fasciotomy, great toe sesamoid excision and nerve entrapment release

Goals • Following surgical correction, incorporate de-weighting into rehabilitation protocol • Develop a progressive return to activity • Maintain fitness and function during rehabilitation

History Plan • Athlete was diagnosed with plantar • Program duration was for 10 weeks fasciitis and fx sesamoid • AlterG Anti-Gravity Treadmill • Upon consultation with treating was incorporated at week five of physician, a complementary conditioning rehabilitation once athlete was cleared program was developed for unrestricted weight bearing Athlete • incorporating the AlterG Anti-Gravity achieved desired competition goals Treadmill • Along with traditional medical treatment; modalities, therapeutic exercise, joint mobilization, and NSAID’s, the AlterG Anti-Gravity Treadmill was added to the treatment protocol

History Progression BEGIN WEIGHT-BEARING Considerations Range of Motion • Pain/ soreness levels were considered Gait evaluation/ re education and used to gauge weight percentage Phase I Neuromuscular activation and speed Week 5-6 Neuromuscular conditioning • Athlete feedback was considered prior Pain Management to each workout Pre and post workout Proprioception pain was recorded

EARLY UNRESTRICTED AMBULATION Results Emphasize heel to walk The athlete was released for return to Pain free activity sport by the treating physician after Proprioception Initiate cardiovascular training 15 weeks of rehabilitation. The athlete Phase II achieved the goals of the rehabilitation Week 7-9 Increase load bearing plan, incorporating a progressive sport Increase volume Increase strike frequency specific conditioning plan to transition the Increase musculoskeletal athlete to full participa- tion. The AlterG strength and endurance Anti-Gravity Treadmill was incorporated Decrease incline of surface into the athletes rehabilitation plan to maintain fitness, manage gait and progressively increase impact on PREPARATION the extremity. The athlete resumed Full foot strike Increase intrinsic muscular unrestricted activity 4 weeks after release function from rehabilitation and continued using Proprioception/Technique Phase III the AlterG Anti-Gravity Treadmill as part Maintain volume Week of the conditioning program. Increase intensity/ load 10-12 Increase musculoskeletal strength and conditioning Increase cardiovascular training Decrease angle of surface Decrease incline of surface

RETURN TO ACTIVITY Increase load and intensity Challenge Propioception Phase IV Maintain Volume Week 13-15 Maintain Conditioning Maintain Technique Maintain angle of surface