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Lower Leg

Degenerative Breakdown ~
Foot Degeneration often involves flattening & pronation  bones become compressed, which increases
chances of…
a) Stress Facture
b) Metatarsalgia ~ Neuroma’s
c) Plantar Fasciitis
d) Achilles Tendonitis  Fishtailing of Tendon
 Puts knee into Valgus (knee collapses in)
 Hip externally rotates (piriformis tightens)

Calf
1) Disharmony b/t Plantar & Dorsiflexors
• When one group becomes tight the other will follow
• If you txt one group & donot get the results, treat both foot
2) Fibularis (Peroneus) Muscle Group
• Stabilizes the ankle from inversion b/c peroneus is main eversion (fyi: fibula is the bone that prevents eversion
of foot)
• Can allow “sloshing” ~ No Excessive Movement

Posterior Calf Anterior Calf Basic Foot/Arch


Gastrocnemius – 2 Mpt Anterior Tibalis – 2 Mpt SP 4
3-4cun below KI 10 ST 36 KI 2
2-3cun below UB 39 2cun below ST 36
Soleus – 3 Mpt Peroneus Longus – 1 Mpt
1cun posterior to SP 8 1-2cun below Fibular Head
½ b/t SP 7 & SP 8
3cun inferior to fibular head,
posterior to Fibula

Common Injuries ~
1) Shin Splint (Mid-Tibial Stress Syndrome –MTSS)
• Microtearing of muscle at attachment close to bone OR pulling of peri-osteum (does not involve abnormal
tendon)
• 2 Types: Anterior (Anterior Tibialis) OR Posterior (Posterior Tibialis)
• Common for patient to have flat feet, disharmony b/t Dorsi & Plantar Flexors, & Tight Gastroc/Soleus.
• Risk Factor: Running, Jumping  Impact on heel
• Check Footware & Running Surfaces (every 300miles)
Protocol ~
1) Special Needle Technique ~ Thread Insertion of Tibialis (Anterior or Posterior)
2) Anterior Calf Protocol
+ Posterior Calf Protocol if txt not improving
HW ~
• Stretch Gastroc & Soleus

2) Stress Fracture of Tibia ~ continuation of shin splints


• Txt is same ~ release all muscle that attach to Tibia
• Check Life Style ~ Diet, Overtraining, Malnourishment (esp Eating Dz)

3) Achilles Tendonitis
• Less vascularity in regions 2-6cm above the insertion of the Achilles, but also the location where fish-tailing of
the tendon occurs ~ if calcaneous is rotated/turned to side, then tendon bends/curves to stay connected to the
muscle  rub/irritated
• Etiology: Tight Gastroc & Soleus, Tight Anterior Tibialis, Flat Feet/Pronation
Protocol ~
1) Special Needle Technique ~ Thread Tendon
2) Posterior Calf Protocol
+ Anterior Calf Protocol if txt not improving
4) Ankle Sprain ~ 85% are lateral/Inversion
• Common for peroneus longus to become inhibited (arthrogenic inhibition – ankle sends info to brain to
SHUT OFF  fall down)
• Common for Jt to become “Jammed” & Deep needling into GB 40 releases the jammed at T/C Jt
Protocol ~
1) Deep GB 40
2) Anterior Calf Protocol
+ Posterior Calf Protocol if txt not improving
• Other txt –
Traction, Exercises, ROM (ABC’s w/Toes), Stretch – Gastroc & Soleus (FYI – stretch for gastroc & soleus is
slightly different – do both)
Strengthen – 4 direction w/Weight in a Sock
Proprioception – re-integrate – Qi Gong/Tai Chi involving moving around on 1 leg – make sure alignment is
correct OR simply balance on 1 leg  with eyes closed

5) Plantar Fasciitis (Heel Spurs) – stretching of shortened tendon


• Attachments are tender to touch
• Often related to Pronation or Fallen Arches
• FYI: Feels better when wearing heels –
Protocol ~
1) Thread both sides of the insertion
2) Foot/Arch Protocol
+ Post Calf if no improvement
+Ant Calf if no improvement
HW ~
o Self massage w/Tennis Ball or can of soup
o Stretch Gastroc or Soleus
o 701 Plasters – also can help reduce superficial bone spurts
• Txt Internally – SP, KI, LV pathology