Fibromyalgia

Case Study: Managing Fibromyalgia-Related Hip and Ankle Pain with Formthotics

Summary

Chronic musculoskeletal pain presents a significant challenge for both patients and clinicians, especially when layered with conditions like fibromyalgia. This case study explores the journey of a 43-year-old self-employed woman, Patient MM, who struggled with unresolved anterior hip pain and calf discomfort due to her fibromyalgia. Despite undergoing consistent physiotherapy and exercise-based rehabilitation, long-term relief remained elusive - until she was introduced to a custom orthotic solution using Formthotics.

This detailed clinical case outlines the assessment, treatment approach, and outcome, showing how Formthotics orthoses, combined with manual therapy and movement retraining, supported MM’s return to pain-free activity.

Practioner: Richard van Plateringen

Practice: Dunedin Podiatry

Patient: MM

Activity Level: Medium

Medical History: Diagnosed with fibromyalgia 20 years ago

Main Complaint: Persistent left hip and calf pain, stiffness in the left ankle during weight-bearing activities

History of Presenting Complaint

MM was referred by her physiotherapist for a non-resolving, 12-month history of functional muscle pain and hip stiffness, exacerbated by standing and walking. Previous treatments included hip and pelvic mobilisations and fascial release targeting iliopsoas, rectus femoris, and adductors, yielding only short-term relief. Prescribed exercises, such as calf raises, increased her pain, especially in the left calf.

Clinical Assessment

A comprehensive biomechanical assessment revealed:

• Postural Issues: Genu valgum more prominent on the left; pelvic rotation; dropped left iliac crest

• Foot Mechanics: Navicular drop and high supination resistance on the left foot; possible Functional Hallux Limitus

• Muscle Activation: Poor tibialis anterior and EDL strength on the left; peroneus longus not activating

• Balance & Mobility: Left-side instability, limited ankle dorsiflexion, reduced posterior glide, and poor intrinsic foot function

• Gait Observations: Lateral foot contact and medial loading on the left; abductory twist on the right foot with greater right arm swing

Treatment Plan

The treatment involved a multi-modal approach:

Orthotic Intervention

• Orthotic Type: Original Single Medium Formthotics

Modifications:

• 4mm heel raise on the left (extended to midfoot)

• Bilateral rearfoot medial skive for subtalar joint correction

• Lateral heel balancing

• 2mm extended PMP (Proximal Metatarsal Pad) to support sagittal movement

Manual Therapy and Rehabilitation

• Mobilisation and manipulation to restore ankle ROM

• Functional stability training: tripod holds, ankle evertor and extensor engagement

• Continued hip strengthening under physiotherapy guidance

Outcome

Within ten days, MM reported notable improvements, although some pain persisted with prolonged standing. She recognised the corrective impact of the Formthotics, noting discomfort and imbalance when not wearing them. Functional strength and compliance with exercises had also improved.

After a small orthotic adjustment and additional manual therapy sessions, MM resumed hill tramping within three months, experiencing minimal discomfort. She continues to wear the Formthotics comfortably and follows a maintenance plan involving quarterly reviews.

Conclusion

This case demonstrates the importance of a comprehensive biomechanical assessment and a customised orthotic solution in managing complex pain presentations, especially in patients with fibromyalgia. The integration of Formthotics orthoses significantly enhanced MM's mobility, balance, and quality of life, highlighting their role as a critical tool in conservative podiatric care.