Tag: plantar fasciitis

Cluffy Wedge

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The Cluffy wedge is a pad that is places under the great toe to hold it in a slightly dorsiflexed position. It is designed to treat functional hallux limitus and problems with the windlass mechanism.

The Cluffy Wedge is a trademarked pad designed to sit under the hallux (your big toe), aiming to hold it in a gently dorsiflexed position—that is, lifted upward just enough to get things moving right. Originally developed by Dr. James Clough, DPM, this wedge was first trademarked in 2003 under Cluffy LLC in Polson, Montana, and has also been marketed under the name P4 Wedge.

Functionally, the Cluffy Wedge is all about managing a condition called functional hallux limitus—where your big toe has a normal range of motion when off the ground but gets stuck when you’re weight-bearing. By dorsiflexing the hallux, the wedge preloads the toe so the windlass mechanism (which tightens the plantar fascia during walking) kicks in earlier and more naturally . The theory is sound: first metatarsal loading improves, less strain is placed on the other metatarsals, and the foot’s biomechanics get realigned—at least hypothetically.

On the practical side, you can use the Cluffy Wedge on its own inside shoes, under insoles, or as an extension in custom orthotics. While some podiatric labs initially offered it, most now craft their own versions to achieve the same effect—often by adding padding under the hallux in custom orthotic designs. However, it’s important to note that peer-reviewed clinical trials are lacking, so much of what we have are anecdotal reports, small-scale studies, or theses—not yet full clinical validation.

In short, the Cluffy Wedge stands out as a simple yet biomechanically savvy tool for specific foot dysfunctions, especially functional hallux limitus. While its theoretical benefits—like balancing forefoot pressure and reactivating the windlass mechanism—are appealing, we remain a bit short on robust clinical research. Still, for patients and practitioners looking for non-invasive ways to support hallux mechanics, it’s worth considering, especially if integrated thoughtfully into custom orthotic planning.

Most Useful Resources:
Cluffy Wedge (Foot Health Forum)
Cluffy Wedge (Podiatry Arena)
Cluffy Wedge (Clinical Biomechanics Bootcamp)
Cluffy Wedge (PodiaPaedia)
The Cluffy Wedge (Podiatry Update)
Cluffy Wedge (Podiatry Experts)
Cluffy Wedge (Podiatry TV)

Baxters Nerve Entrapment

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Baxter nerve entrapment is a cause of heel pain with the symptoms often mimicking plantar fasciitis and should be conisdered in any case of heel pain the has a neurological component to it.

Baxter’s nerve entrapment, also known as inferior calcaneal nerve entrapment, is a relatively common but often overlooked cause of chronic heel pain. The Baxter’s nerve is the first branch of the lateral plantar nerve, and it runs beneath the abductor hallucis muscle before traveling along the medial side of the heel. Because of its position, it is vulnerable to compression as it passes between surrounding structures, particularly the abductor hallucis and the medial calcaneal tuberosity. This entrapment can mimic or coexist with plantar fasciitis, which is why it is frequently misdiagnosed.

The clinical presentation of Baxter’s nerve entrapment usually involves sharp, burning, or radiating pain on the inside of the heel that may worsen with prolonged standing, walking, or running. Unlike classic plantar fasciitis, which is typically most painful during the first steps in the morning, Baxter’s nerve pain can persist throughout the day and sometimes worsens with activity. Patients may also report tingling or numbness along the heel or arch, as the compressed nerve is both sensory and motor. Chronic cases can even lead to weakness of the abductor digiti quinti muscle in the foot.

Risk factors and causes often include repetitive overuse in runners, foot deformities such as flat feet or overpronation, and tightness of the abductor hallucis muscle. External factors, like ill-fitting shoes or excessive standing on hard surfaces, can also contribute to entrapment. In many athletes, the combination of repetitive heel impact and biomechanical stress creates a perfect environment for irritation of the nerve. Because these symptoms overlap with plantar fasciitis, imaging such as MRI or ultrasound, along with careful physical examination, is usually needed to confirm the diagnosis.

Treatment strategies for Baxter’s nerve entrapment focus on reducing nerve compression and inflammation. Conservative options include rest, orthotic devices to correct foot mechanics, stretching of the calf and abductor hallucis, and targeted physical therapy. Anti-inflammatory medications or corticosteroid injections may be used in persistent cases. For patients who do not respond to conservative care, surgical decompression of the nerve can be considered, which generally provides significant relief. Early recognition is important, as untreated entrapment can lead to chronic heel pain and functional limitations.

Most Useful Resources:
Baxters Nerve Entrapment (PodiaPaedia)
Baxter’s Neuritis (Medial Calcaneal Nerve Neuritis) (Podiatry Arena)
Baxter’s neuropathy secondary to plantar fasciitis (Podiatry Arena)
Baxters Nerve Entrapment (Podiatry TV)
Baxters nerve or plantar fasciitis? (Podiatry Experts)
Baxters Nerve Entrapment (Foot Health Forum)

Rupture the plantar fascia to treat plantar fasciitis

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This is something of a legend that happened in Australia where a footballer with a chronic plantar fasciitis allegedly jumped from a height in order to rupture his plantar fascia to facilitate healing. A surgical cutting of the plantar fascia is often used to treat chronic plantar fasciitis. It apparently worked.

Most Useful Resources:
Deliberate Rupture of Plantar Fascia to Treat Plantar Fasciitis (PodiaPaedia)
Rupture the plantar fascitis to help? (Podiatry Experts)
Deliberate rupture of plantar fasica to treat plantar fasciitis (Podiatry Arena)

Treatment for a plantar fascia rupture typically involves a combination of conservative measures and, in some cases, surgical intervention:

Rest and immobilization: Initially, it’s important to rest the affected foot and avoid activities that worsen the pain. Immobilization through the use of a walking boot, cast, or crutches may be necessary to allow the plantar fascia to heal.

Ice therapy: Applying ice to the affected area as soon as it happend can help reduce pain and inflammation. Ice packs or frozen water bottles can be used for 15-20 minutes several times a day.

Pain management: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help alleviate pain and reduce inflammation. Always consult a healthcare professional before taking any medication.

Physical therapy: A physical therapist may provide specific exercises to stretch and strengthen the muscles and tissues surrounding the foot and ankle. These exercises can help improve mobility, reduce pain, and promote healing.

Orthotic devices: Wearing orthotic devices, such as arch supports or custom-made shoe inserts, can help alleviate stress on the plantar fascia and provide support during the healing process.

Night splints: Night splints are devices worn while sleeping to keep the foot and ankle in a stretched position, which can help prevent the plantar fascia from tightening and promote healing.

Extracorporeal shock wave therapy (ESWT): In some cases, ESWT may be recommended. This treatment involves using shock waves to stimulate healing and reduce pain.

Surgical: If thee above conservative measure do not help, then surgery is an option.

Corticosteroid injections: Corticosteroid injections may be considered if conservative treatments are not effective. However, these injections are generally used sparingly due to potential risks.

Surgical intervention: Surgery is typically considered only when conservative treatments fail to provide relief. Surgical options may include plantar fascia release, where the tight or damaged portion of the plantar fascia is surgically cut or detached to relieve tension.