PHYSIOTHERAPIST: BALDACCHINI MANUELE
Mr. Marco, 40 years old, office worker, regularly practices walking daily. He does not take any medications.
The patient reports maximum pain located in the PE LA-AN left for the past 5 months, with a VAS score ranging from 4 to 8.
The pain is described as burning and stabbing, occasionally radiating beyond the metatarsal heads toward the lateral three toes. Symptoms worsen when wearing formal/tight shoes, when the foot is exposed to cold, after walking (pain increases from VAS 4 to 8). Despite this, the pain does not limit activities of daily living (ADLs).
The patient reports intermittent LU-PV RE LA left for the past 10 years. Triggered by heavy activities (e.g., gardening), with a Pain intensity: VAS 0–5, manageable and never previously treated, the patient attributes it to a low muscular strength.
The patient had a right ankle trauma (TA DX) 16 years ago, treated surgically, followed by 1 month of non-weight bearing with crutches and a left varicocele surgery (AN ME PV SX) at age 17
Clinical Hypothesis
The body has developed a maladaptive compensatory strategy following the right ankle trauma, leading to overload initially in the left lower limb (LU SX) and subsequently in the left foot (PE SX).
Mulder’s test: strongly positive (+++)
Movement Verification (Verifica Motoria)
TA: Frontal plane: right **, left **
PE: Frontal plane: right *, left ***. Sagittal plane: right **, left *
LU: Frontal plane: right *, left ***. Sagittal plane: right *, left *
Palpatory Verification
TA: RE left *, AN right *; LA-ME left *, ME right ***; LA right *
PE: LA left ***, ME left *; ME right *
LU: LA left * (uncertain finding → pelvic area also assessed)
PV: LA right ***, LA left *
Treatment
Based on the assessment, treatment focused on the frontal plane, starting from: ME-RA DX and LA-PV DX. After treating these two points, pain decreased from VAS 4 to VAS 2 then the treatment continued with left LA PE, specifically: Expansion between the 3rd and 4th rays, proximally near the metatarsophalangeal joint toward the 3rd ray , Adjacent intertarsal space, also proximal to the metatarsophalangeal joint
Outcome
At the end of the session: VAS score was 0; significant improvement in movement verification of the lower limb and ankle; Slight residual positivity in frontal plane movement of the left foot and Mulder’s test became negative
Follow-up
A second session is recommended to evaluate the clinical progression and stability of results.