case presentation by pathum

1. Case presentation

2. Subjective Examination
 Name – Mrs.weerasinghe
 Age – 65yrs old
 Occupation- retired nursing sister
 Civil status – Married
Has two children
 History of complaints – pain occurred 6 months ago.
-Pain started in the upper aspect of the posterior
side of the leg .
-Pain radiated into lower aspect of the leg and
heel.
-Pain occurred gradually

3.  severe pain occurred in heel and posterior aspect of the right
lower limb when walking
 Pain in the medial side of the right calf area
 Felt numbness in the fingers of the right side foot .
 Morning stiffness more than 30 mints
 Pain aggravating factors- During weight bearing activities
(walking ,running..)
 Relieving factors – during lying down, rest
Past medical history
Hypertension – take medications
Past surgical history - No

4. Observation ( Pt is standing)
 Posture
1 Anterior - swelling in upper aspect of the Right foot
2) posterior – swelling around the Right Achilles tendon
3) Lateral- Foot arch is reduced
 Gait : Abnormal, patient is walking while limping on right
leg

5. Palpation
 Tenderness over the right calf muscles & sole of the foot
 Pitting edema on the fat pad around the Achilles tendon
 Jump sign when palpating the Calf muscles of right lower leg (
Trigger points)
 Right calf muscle tightness
Test
- ROM Movement AROM PROM
Dorsiflexion 10 15
planterflexion 45 50
Eversion
Inversion
15
30
22
34

6.  Muscle power testing- According to MRC Scale
 Special tests
ThompsonTest – Negative (No any Achilles tendon
rupture)
Muscle Group Muscle Power
Dorsi flexors 5
Plantar flexors 4
Pronators 4
Supinators 4

7. Physiotherapy Diagnosis
 Right Ankle movements are limited due to pain,
swelling and stiffness..

8. Physiotherapy goals -
1)Pain relief
2) Restoration and maintain the ROM
3)Strengthen the weak muscles

9.  To relief pain
Ultra sound therapy - 1 MHz , 4 mnts , 3 times per week Micro
massage, Heat causes vasodilation and increase circulation, remove waste
products and promote healing .Pain is reduced prior to exercises
Soft tissue Mobilization
Effleurage and kneading (To reduce swelling & increase circulation) -
Static friction (To release trigger points)
Deep transverse friction
 To restoration of movements
-Active mobility exercises – 5 minutes
-Active calf stretching exercises - (3-5 times per week)-To
reduce muscle tightness

10.  To strengthen the muscles
- Eccentric loading - Standing on toes
-Thera band resisted exercises for ankle planter flexors,
Invertors & evertors

11. Pathum Asanka
UCP/AL/11/210