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http://physiotherapy-in.blogspot.com/, http://www.adityaphysio.com/

Dr.Ashutosh Srivastav -PT, Teacher Colony, PIPIGANJ, Gorakhpur (2026)

27/08/2026

𝗠𝗲𝗱𝗶𝗮𝗹 𝗞𝗻𝗲𝗲 𝗣𝗮𝗶𝗻 𝗕𝗲𝗹𝗼𝘄 𝗧𝗵𝗲 𝗝𝗼𝗶𝗻𝘁 𝗟𝗶𝗻𝗲? 𝗧𝗵𝗶𝗻𝗸 𝗣𝗲𝘀 𝗔𝗻𝘀𝗲𝗿𝗶𝗻𝗲 𝗕𝘂𝗿𝘀𝗶𝘁𝗶𝘀

Not every case of medial knee pain is a meniscus tear or MCL injury.

Sometimes the pain comes from a small bursa located below and slightly behind the medial knee joint line:

👉 𝗣𝗲𝘀 𝗔𝗻𝘀𝗲𝗿𝗶𝗻𝗲 𝗕𝘂𝗿𝘀𝗶𝘁𝗶𝘀

The pes anserinus is formed by the tendons of sartorius, gracilis and semitendinosus, inserting on the anteromedial proximal tibia. The bursa lies deep to these tendons.

📍 𝗪𝗵𝗲𝗿𝗲 𝗜𝘀 𝗧𝗵𝗲 𝗣𝗮𝗶𝗻?

• Inner side of the knee
• Typically about 4–7 cm below the medial joint line
• Localized tenderness over the proximal medial tibia
• Usually no true intra-articular locking
• Pain may increase with stairs or rising from a chair

⚠️ 𝗪𝗵𝗮𝘁 𝗖𝗮𝗻 𝗖𝗼𝗻𝘁𝗿𝗶𝗯𝘂𝘁𝗲?

Commonly associated factors include:

• Repetitive running or sports activity
• Hamstring tightness
• Genu valgum
• Pes planus / altered lower-limb alignment
• Knee osteoarthritis
• Higher body weight
• Direct local trauma
• Repetitive valgus and rotational loading

🔍 𝗧𝗵𝗲 𝗞𝗲𝘆 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗖𝗹𝘂𝗲

👉 Location matters.

Medial meniscus:
📍 Tenderness usually at the medial joint line

Pes anserine region:
📍 Tenderness is distal to the joint line, over the anteromedial proximal tibia.

This distinction can be extremely useful when assessing medial knee pain.

🏃 𝗪𝗵𝗼 𝗠𝗮𝘆 𝗗𝗲𝘃𝗲𝗹𝗼𝗽 𝗜𝘁?

It can occur in:

• Runners and other athletes
• People with knee OA
• Individuals with valgus alignment
• People with pes planus
• Middle-aged and older adults

Importantly, pes anserine pain is not exclusive to one demographic and can occur in athletic populations as well.

🆚 𝗣𝗲𝘀 𝗔𝗻𝘀𝗲𝗿𝗶𝗻𝗲 𝗩𝘀 𝗠𝗲𝗱𝗶𝗮𝗹 𝗠𝗲𝗻𝗶𝘀𝗰𝘂𝘀

Pes Anserine Bursitis
📍 Pain below the joint line
🎯 Focal tenderness over pes anserine insertion
🪜 Often aggravated by stairs/rising
❌ Usually no true mechanical locking

Medial Meniscus Pathology
📍 Joint-line tenderness
🔄 Often associated with twisting
🔒 Catching/locking may occur
💧 Effusion may be present

These conditions can coexist, so clinical examination should not rely on location alone.

💪 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁

Most cases are managed conservatively.

• Reduce aggravating activities temporarily
• Ice for symptom relief when appropriate
• Hamstring flexibility work
• Progressive quadriceps strengthening
• Hip and lower-limb strengthening
• Address relevant alignment and movement factors
• Gradual return to running/sport

Physical therapy and exercise are commonly used as first-line management, while injections may be considered for persistent symptoms after appropriate assessment. Surgery is rarely required.

🩻 𝗗𝗼 𝗬𝗼𝘂 𝗡𝗲𝗲𝗱 𝗔𝗻 𝗠𝗥𝗜?

Not necessarily.

Pes anserine bursitis is primarily a clinical diagnosis. Imaging can be useful when the diagnosis is uncertain or when another pathology needs to be excluded.

📌 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗧𝗮𝗸𝗲𝗮𝘄𝗮𝘆

Medial knee pain ≠ automatically a meniscus tear.

If the tenderness is several centimetres below the medial joint line, examine the pes anserine region.

🧠 Localize the pain before naming the pathology.

👨‍⚕️ Dr Ashutosh Srivastav PT
Neuro • Ortho • Sports Rehabilitation

📚 References

• Mohseni M, Mabrouk A, Li D. Pes Anserine Bursitis. StatPearls. Updated 2024; available in NCBI Bookshelf.

• Knee Bursae: A Comprehensive Review of Clinical Evaluation, Imaging Differentiation, and the Expanding Role of Biologic Therapies. 2025 systematic review.

• MRI characteristics of cysts and “cyst-like” lesions in and around the knee. Review of anserine bursitis and its differential diagnosis.

27/08/2026

🧿🧿🙏🙏

26/08/2026

𝗟𝗮𝘁𝗲𝗿𝗮𝗹 𝗞𝗻𝗲𝗲 𝗣𝗮𝗶𝗻 𝗪𝗶𝘁𝗵 𝗖𝗹𝗶𝗰𝗸𝗶𝗻𝗴? 𝗧𝗵𝗲 𝗣𝗿𝗼𝗯𝗹𝗲𝗺 𝗠𝗶𝗴𝗵𝘁 𝗕𝗲 𝗧𝗵𝗲 𝗙𝗶𝗯𝘂𝗹𝗮𝗿 𝗛𝗲𝗮𝗱

When a patient has pain on the outer side of the knee with popping, catching or a feeling of instability, the first thoughts are often:

• Lateral meniscus injury
• IT Band Syndrome
• LCL injury

But an overlooked structure can sometimes be responsible:

👉 𝗣𝗿𝗼𝘅𝗶𝗺𝗮𝗹 𝗧𝗶𝗯𝗶𝗼𝗳𝗶𝗯𝘂𝗹𝗮𝗿 𝗝𝗼𝗶𝗻𝘁 (𝗣𝗧𝗙𝗝) 𝗗𝘆𝘀𝗳𝘂𝗻𝗰𝘁𝗶𝗼𝗻

The PTFJ is a small synovial joint between the fibular head and lateral tibia, located just below the lateral knee. Although small, it contributes to lower-limb biomechanics and helps accommodate rotational forces transmitted between the ankle and knee.

📍 𝗪𝗵𝗲𝗿𝗲 𝗜𝘀 𝗧𝗵𝗲 𝗣𝗮𝗶𝗻?

• Localized pain around the fibular head
• Lateral or posterolateral knee discomfort
• Pain may radiate toward the lateral calf or ankle
• Tenderness directly over the PTFJ
• Sometimes associated with clicking, popping or a sense of instability

⚠️ 𝗪𝗵𝗮𝘁 𝗖𝗮𝗻 𝗖𝗮𝘂𝘀𝗲 𝗜𝘁?

Potential contributors include:

• Previous ankle or knee trauma
• Twisting injuries
• Recurrent subluxation/dislocation
• Generalized ligamentous laxity
• Repetitive rotational loading
• Degenerative changes of the joint

🔍 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗖𝗹𝘂𝗲𝘀

✔️ Pain reproduced by palpating the fibular head

✔️ Pain or abnormal movement with PTFJ mobilization

✔️ Popping or excessive fibular-head movement compared with the opposite side

✔️ Symptoms may be reproduced while combining PTFJ loading with ankle movement.

🆚 𝗣𝗧𝗙𝗝 𝗣𝗮𝘁𝗵𝗼𝗹𝗼𝗴𝘆 𝗩𝘀 𝗟𝗮𝘁𝗲𝗿𝗮𝗹 𝗠𝗲𝗻𝗶𝘀𝗰𝘂𝘀

PTFJ dysfunction/instability
📍 Pain is often maximal around the fibular head
🔄 Popping or instability may be prominent
🦵 Symptoms can be influenced by ankle and tibiofibular mechanics

Lateral meniscus pathology
📍 More typical joint-line tenderness
🔒 May produce catching/locking
💧 Joint effusion may occur

A careful examination is essential because PTFJ instability is uncommon and can be mistaken for lateral meniscal pathology.

🧠 𝗗𝗼𝗻’𝘁 𝗙𝗼𝗿𝗴𝗲𝘁 𝗧𝗵𝗲 𝗖𝗼𝗺𝗺𝗼𝗻 𝗣𝗲𝗿𝗼𝗻𝗲𝗮𝗹 𝗡𝗲𝗿𝘃𝗲

The common peroneal (fibular) nerve winds around the fibular neck.

Therefore, significant PTFJ instability or trauma around the fibular head should prompt a neurological examination for:

• Foot dorsiflexion weakness
• Toe extension weakness
• Sensory changes over the dorsum of the foot
• Foot drop

PTFJ pathology and peroneal nerve compression can coexist.

💪 𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁

For stable or less severe cases, management may include:

• Activity modification
• Temporary reduction of provocative loading
• Supportive taping/strap when appropriate
• Lower-limb strengthening
• Hip and ankle rehabilitation
• Balance and neuromuscular training
• Correction of relevant kinetic-chain factors

Persistent symptomatic instability may require orthopedic assessment. Surgical options can include ligament reconstruction or stabilization procedures in appropriately selected patients.

📌 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗧𝗮𝗸𝗲𝗮𝘄𝗮𝘆

Lateral knee pain ≠ always ITBS or meniscus pathology.

If the pain is precisely around the fibular head and accompanied by popping, catching or abnormal fibular-head mobility, examine the proximal tibiofibular joint.

🧠 Sometimes the “knee pain” is actually coming from the small joint beside the knee.

👨‍⚕️ Dr Ashutosh Srivastav PT
Neuro • Ortho • Sports Rehabilitation

📚 References

• Miller TL, Curatolo C. Proximal Tibiofibular Joint Instability: An Underrecognized Cause of Lateral Knee Pain and Mechanical Symptoms. JAAOS. 2023;31(8):e412–e423.

• Zhai Y, et al. Anatomy, biomechanics, and clinical advances of proximal tibiofibular joint in pain management. Frontiers in Surgery. 2025.

• Parker DA, et al. Proximal Tibiofibular Joint Instability and Treatment Approaches: A Systematic Review of the Literature. Arthroscopy.

26/08/2026

Part 1- 🧠 Stroke rehabilitation is not just about strengthening muscles — it’s about retraining the brain.

After a stroke, the nervous system begins a complex process of recovery through neuroplasticity, repetition, sensory input, and functional movement training. Early physiotherapy and consistent rehabilitation can significantly improve mobility, balance, coordination, and independence.

Recovery may be slow, but every movement matters. Every repetition teaches the brain to reconnect and adapt.

Stroke rehab focuses on: ✔️ Motor relearning
✔️ Balance & gait training
✔️ Spasticity management
✔️ Functional independence
✔️ Neuroplasticity-based recovery

With proper rehabilitation, many stroke survivors can regain confidence, mobility, and quality of life. 💙

StrokeAwareness Neuroplasticity Rehabilitation Physio PhysicalTherapy BrainRecovery Hemiplegia StrokeSurvivor GaitTraining BalanceTraining Spasticity FunctionalRecovery MedicalEducation Physiotherapist RehabScience Healthcare NeuroPhysio RecoveryJourney DrAshutoshSrivastavPT

26/08/2026

Terrible floods in Nepal. Prayers 🙏

26/08/2026

4 best exercises for Shoulder

26/08/2026

𝗢𝘂𝘁𝗲𝗿 𝗞𝗻𝗲𝗲 𝗣𝗮𝗶𝗻 𝗪𝗵𝗶𝗹𝗲 𝗥𝘂𝗻𝗻𝗶𝗻𝗴? 𝗜𝘁 𝗠𝗶𝗴𝗵𝘁 𝗕𝗲 𝗜𝗧 𝗕𝗮𝗻𝗱 𝗦𝘆𝗻𝗱𝗿𝗼𝗺𝗲

A runner develops sharp pain on the outside of the knee that appears after a certain distance and becomes worse with downhill running.

Many athletes simply call it “runner’s knee.”

But one important diagnosis to consider is:

🏃 𝗜𝗹𝗶𝗼𝘁𝗶𝗯𝗶𝗮𝗹 𝗕𝗮𝗻𝗱 𝗦𝘆𝗻𝗱𝗿𝗼𝗺𝗲 (𝗜𝗧𝗕𝗦)

It is a common overuse injury in runners and other endurance athletes. Contemporary evidence suggests that the problem is more complex than simply an IT band “rubbing” over the bone. Compression/impingement of tissues around the lateral femoral epicondyle and altered lower-limb mechanics may contribute.

📍 𝗪𝗵𝗲𝗿𝗲 𝗜𝘀 𝗧𝗵𝗲 𝗣𝗮𝗶𝗻?

• Localized pain over the lateral aspect of the knee
• Often near the lateral femoral epicondyle
• Usually no significant pain at rest initially
• Pain may begin only after running for a particular distance

⚠️ 𝗪𝗵𝗮𝘁 𝗧𝗿𝗶𝗴𝗴𝗲𝗿𝘀 𝗜𝗧𝗕𝗦?

Common contributing factors include:

• Sudden increase in running mileage
• Excessive hill or downhill running
• Repetitive knee flexion–extension
• Training-load errors
• Altered running mechanics
• Reduced hip strength/control in some runners
• Increased hip adduction and knee internal rotation may be associated with ITBS in certain populations.

🔍 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗖𝗹𝘂𝗲𝘀

✔️ Focal tenderness around the lateral femoral epicondyle

✔️ Pain reproduced with repetitive knee flexion/extension under load

✔️ Symptoms often increase during running, especially downhill

✔️ Pain may appear at a predictable point during a run

🆚 𝗜𝗧𝗕𝗦 𝗩𝘀 𝗟𝗮𝘁𝗲𝗿𝗮𝗹 𝗠𝗲𝗻𝗶𝘀𝗰𝘂𝘀 𝗣𝗮𝘁𝗵𝗼𝗹𝗼𝗴𝘆

IT Band Syndrome
📍 Lateral femoral epicondyle region
🏃 Strongly associated with repetitive running
🔄 Usually load-related pain

Lateral Meniscus Pathology
📍 More directly associated with joint-line tenderness
🔒 May involve catching, locking or joint effusion
🦵 Often associated with twisting or traumatic mechanisms

Clinical examination should always consider the complete differential rather than relying on a single test.

💪 𝗛𝗼𝘄 𝗜𝘀 𝗜𝗧𝗕𝗦 𝗧𝗿𝗲𝗮𝘁𝗲𝗱?

The goal is not simply to “stretch the IT band.”

A rehabilitation program may include:

• 📉 Temporary modification of running load
• 🦵 Progressive hip-abductor and lower-limb strengthening
• 🎯 Neuromuscular control training
• 🏃 Gradual return-to-running progression
• 👟 Assessment of training variables and footwear
• 🔄 Gait retraining in selected runners
• Manual therapy or other adjuncts when appropriate

A 2024 systematic review found hip-abductor strengthening to be one of the most commonly used and promising components of conservative rehabilitation, although the available studies are heterogeneous and do not establish one universal protocol.

🚫 𝗔 𝗖𝗼𝗺𝗺𝗼𝗻 𝗠𝗶𝘀𝘁𝗮𝗸𝗲

Simply telling every runner:

“Your IT band is tight — stretch it.”

…may be an oversimplification.

ITBS is multifactorial. The rehabilitation plan should address load tolerance, strength, movement control and running mechanics, not just flexibility.

📌 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗧𝗮𝗸𝗲𝗮𝘄𝗮𝘆

Lateral knee pain in a runner ≠ automatically a meniscus tear.

If pain is activity-related, localized to the lateral femoral epicondyle region and consistently provoked by running, IT Band Syndrome should be part of the differential.

🧠 Find the load-related cause. Treat the runner — not just the IT band.

👨‍⚕️ Dr Ashutosh Srivastav PT
Neuro • Ortho • Sports Rehabilitation

📚 References

• Sanchez-Alvarado A, et al. Effects of conservative treatment strategies for iliotibial band syndrome on pain and function in runners: a systematic review. Frontiers in Sports and Active Living. 2024;6:1386456.

• Beals C, Flanigan D. A Review of Treatments for Iliotibial Band Syndrome in the Athletic Population. Journal of Sports Medicine. 2013.

• Aderem J, Louw QA. Biomechanical risk factors associated with iliotibial band syndrome in runners: a systematic review.

25/08/2026

𝗗𝗶𝘇𝘇𝗶𝗻𝗲𝘀𝘀 𝗪𝗶𝘁𝗵 𝗡𝗲𝗰𝗸 𝗣𝗮𝗶𝗻? 𝗧𝗵𝗲 𝗣𝗿𝗼𝗯𝗹𝗲𝗺 𝗠𝗶𝗴𝗵𝘁 𝗡𝗼𝘁 𝗕𝗲 𝗬𝗼𝘂𝗿 𝗜𝗻𝗻𝗲𝗿 𝗘𝗮𝗿

When someone says, “I feel dizzy,” the first thought is often BPPV or another vestibular disorder.

But what if the dizziness is closely linked with neck pain, stiffness or cervical movement?

👉 Consider 𝗖𝗲𝗿𝘃𝗶𝗰𝗼𝗴𝗲𝗻𝗶𝗰 𝗗𝗶𝘇𝘇𝗶𝗻𝗲𝘀𝘀 (𝗖𝗚𝗗).

🧠 𝗪𝗵𝗮𝘁 𝗜𝘀 𝗖𝗲𝗿𝘃𝗶𝗰𝗼𝗴𝗲𝗻𝗶𝗰 𝗗𝗶𝘇𝘇𝗶𝗻𝗲𝘀𝘀?

CGD describes dizziness or disequilibrium occurring in association with neck pain or cervical dysfunction, after other important causes of dizziness have been considered or excluded.

It is thought to involve altered cervical proprioceptive input interacting with the visual and vestibular systems.

🔍 𝗛𝗼𝘄 𝗗𝗼𝗲𝘀 𝗜𝘁 𝗛𝗮𝗽𝗽𝗲𝗻?

Your brain constantly integrates information from:

👁️ Vision
👂 Vestibular system
🦴 Cervical proprioceptors

If cervical sensory information becomes altered because of pain, injury or dysfunction, the information reaching the brain may conflict with visual and vestibular signals.

➡️ This sensory mismatch may contribute to dizziness and postural instability.

📍 𝗪𝗵𝗮𝘁 𝗗𝗼𝗲𝘀 𝗜𝘁 𝗙𝗲𝗲𝗹 𝗟𝗶𝗸𝗲?

Unlike classic spinning vertigo, patients may describe:

• “Floating” or lightheaded sensation
• Unsteadiness or imbalance
• Feeling “off-balance” while walking
• Neck tightness or pain
• Symptoms associated with neck movement
• Cervicogenic headache
• Nausea or visual discomfort

A spinning sensation can occur in dizziness disorders, but CGD is more commonly described as non-spinning dizziness or disequilibrium.

⚠️ 𝗔 𝗖𝗿𝗶𝘁𝗶𝗰𝗮𝗹 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗣𝗼𝗶𝗻𝘁

CGD does NOT have a single gold-standard diagnostic test.

It remains a diagnosis of exclusion, meaning clinicians should first consider other vestibular, neurological, vascular and medical causes of dizziness.

So:

❌ Neck pain + dizziness does not automatically mean CGD.

🧪 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗔𝘀𝘀𝗲𝘀𝘀𝗺𝗲𝗻𝘁

A thorough assessment may include:

✔️ Cervical ROM
✔️ Upper cervical palpation
✔️ Cervical joint-position error/proprioception
✔️ Cervical torsion testing
✔️ Oculomotor assessment
✔️ Balance assessment
✔️ Vestibular examination
✔️ Screening for red flags and alternative diagnoses

Research has identified differences in cervical sensorimotor control and cervical proprioception in people classified as having cervicogenic dizziness, but diagnostic specificity remains limited.

🆚 𝗖𝗚𝗗 𝗩𝘀 𝗕𝗣𝗣𝗩

BPPV
🔄 Typically triggered by specific changes in head position relative to gravity
👂 Vestibular disorder
🧪 Dix-Hallpike or other positional testing may reproduce characteristic symptoms/nystagmus.

Cervicogenic Dizziness
🦴 Associated with neck pain/dysfunction
↔️ Symptoms may be related to cervical movement
🧠 Often presents more as dizziness/disequilibrium than classic spinning vertigo.

💪 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁

Once alternative causes have been appropriately considered, rehabilitation may include:

• Cervical mobility exercises
• Deep cervical muscle strengthening
• Sensorimotor/proprioceptive training
• Eye–head coordination exercises
• Balance training
• Vestibular rehabilitation when indicated
• Manual therapy in appropriately selected patients
• Gradual exposure to provocative movements

Evidence supports an integrated cervical + vestibular rehabilitation approach, rather than repeatedly treating every dizzy patient as BPPV.

📌 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗧𝗮𝗸𝗲𝗮𝘄𝗮𝘆

Not every dizzy patient needs another Epley maneuver.

If dizziness is consistently associated with neck pain, restricted cervical movement and altered cervical sensorimotor control, investigate the cervical contribution — but only after appropriate screening for other causes of dizziness.

🧠 Don’t diagnose the neck first. Exclude the dangerous and common causes first, then assess the cervical contribution.

👨‍⚕️ Dr Ashutosh Srivastav PT
Neuro • Ortho • Sports Rehabilitation

📚 References

• De Hertogh W, et al. Dizziness and neck pain: a perspective on cervicogenic dizziness exploring pathophysiology, diagnostic challenges, and therapeutic implications. Frontiers in Neurology. 2025;16:1545241.

• Li Y, Yang L, Dai C, Peng B. Proprioceptive Cervicogenic Dizziness: A Narrative Review of Pathogenesis, Diagnosis, and Treatment. Journal of Clinical Medicine. 2022;11(21):6293.

• Reiley AS, et al. How to diagnose cervicogenic dizziness. Archives of Physiotherapy. 2017;7:12.

• Cleveland Clinic. Cervical Vertigo (Cervicogenic Dizziness): Symptoms & Treatment. Updated 2026.

25/08/2026

Post Knee Replacement Exercises

24/08/2026

𝗠𝗲𝗱𝗶𝗮𝗹 𝗔𝗿𝗰𝗵 𝗣𝗮𝗶𝗻 𝗜𝗻 𝗥𝘂𝗻𝗻𝗲𝗿𝘀? 𝗜𝘁 𝗠𝗶𝗴𝗵𝘁 𝗕𝗲 𝗔 𝗡𝗲𝗿𝘃𝗲 — 𝗡𝗼𝘁 𝗣𝗹𝗮𝗻𝘁𝗮𝗿 𝗙𝗮𝘀𝗰𝗶𝗶𝘁𝗶𝘀

A runner develops burning pain along the inside of the foot and medial arch.

The usual diagnosis?

👉 “Plantar fasciitis.”

But if the heel is relatively spared and the pain has a burning, tingling or radiating quality, consider an important differential:

🏃‍♂️ 𝗝𝗼𝗴𝗴𝗲𝗿’𝘀 𝗙𝗼𝗼𝘁

Also known as medial plantar nerve entrapment, this is an uncommon peripheral nerve entrapment seen particularly in runners.

👉 𝗪𝗵𝗮𝘁 𝗜𝘀 𝗜𝘁?

• Compression/irritation of the medial plantar nerve
• The nerve branches from the tibial nerve in the tarsal tunnel
• It supplies sensation to the medial plantar foot and medial toes
• It also supplies several intrinsic foot muscles

🔍 𝗪𝗵𝗲𝗿𝗲 𝗖𝗮𝗻 𝗜𝘁 𝗚𝗲𝘁 𝗧𝗿𝗮𝗽𝗽𝗲𝗱?

Common sites include:

• The fibro-osseous canal near the navicular tuberosity and abductor hallucis
• The Master Knot of Henry, where the FHL and FDL tendons cross
• Less commonly, around a space-occupying lesion or tendon pathology

⚠️ 𝗪𝗵𝘆 𝗗𝗼 𝗥𝘂𝗻𝗻𝗲𝗿𝘀 𝗚𝗲𝘁 𝗜𝘁?

Potential contributors include:

• High-volume or long-distance running
• Excessive pronation / hindfoot valgus
• Repetitive traction on the nerve
• Abductor hallucis muscle or fascial compression
• Foot-structure abnormalities
• Poorly tolerated footwear or orthotic pressure

📍 𝗧𝘆𝗽𝗶𝗰𝗮𝗹 𝗦𝘆𝗺𝗽𝘁𝗼𝗺𝘀

• Burning or aching pain along the medial arch
• Pain that may radiate toward the first and second toes
• Tingling or numbness in the medial plantar foot
• Symptoms often increase with running
• Usually little or no significant pain at rest

🧪 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗖𝗹𝘂𝗲

Tinel’s sign can be useful.

👉 Percussion over the medial plantar nerve near the navicular tuberosity may reproduce the patient's familiar tingling or electric sensation.

🆚 𝗝𝗼𝗴𝗴𝗲𝗿’𝘀 𝗙𝗼𝗼𝘁 𝗩𝘀 𝗣𝗹𝗮𝗻𝘁𝗮𝗿 𝗙𝗮𝘀𝗰𝗶𝗶𝘁𝗶𝘀

Plantar Fasciitis
📍 Usually maximal at the medial calcaneal tubercle
🔥 Primarily plantar heel pain

Jogger’s Foot
📍 More medial arch/plantar nerve distribution
⚡ Burning, tingling or radiating pain
🔍 Tinel’s sign may reproduce symptoms

💪 𝗠𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁

Treatment should target the mechanical cause of nerve irritation, rather than automatically following a plantar-fascia protocol.

• Relative reduction of aggravating running load
• Footwear assessment
• Correction of relevant biomechanical factors
• Carefully selected orthotic support
• Progressive rehabilitation
• Neural and soft-tissue interventions when clinically appropriate
• Diagnostic/therapeutic nerve injection in selected cases
• Surgical decompression is generally reserved for persistent cases after appropriate conservative management

⚠️ Important: Orthotics are not automatically beneficial. A rigid medial arch support can sometimes increase local pressure and aggravate symptoms, so the response should be monitored individually.

📌 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗧𝗮𝗸𝗲𝗮𝘄𝗮𝘆

Medial arch pain in a runner ≠ automatically plantar fasciitis.

If the pain is burning + exercise-related + radiating toward the medial toes + associated with sensory symptoms, think about the medial plantar nerve.

🧠 Localize the pain. Check the nerve. Then choose the treatment.

👨‍⚕️ Dr Ashutosh Srivastav PT
Neuro • Ortho • Sports Rehabilitation

Dr.Ashutosh Srivastav -PT

27/08/2026

27/08/2026

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