resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Universal Design: Principles & Practice
In many respects, universal design serves as the core of ergonomics. It's also a good tool to use when designing a return-to-work program for injured and/or ill patients. Let's take a closer look at universal design and why it should matter to you and your patients.
Taking the Chiropractic Message to the Press
"There is no better place on earth to have a news event," the National Press Club boasts, and it's easy to understand why: Every year, the 108-year-old Washington, D.C.-based organization hosts countless press conferences on the hottest topics impacting America and often the world.
Balancing Spring Challenges
As the winter months come to a close and warmer spring weather appears, patients may begin to present with new challenging pattern presentations.
A Major Role in Back Pain: The Multifidus
Back pain affects roughly 80 percent of the population at one time or another and is one of the leading causes of doctor visits.
Bill With Confidence: Learn What to Collect
Q: I am trying to understand what I may collect from my patient when there is insurance. Do I have to accept the amount allowed by the plan or may I collect up to my billed amount? Please note, I am not a member of any insurance plan.
An Unexpected Diagnosis: The Result of Lacking Communication
A couple years ago I had a case that showed me the importance of open communication between health practitioners. We need to show up with less fear, and let go of our judgments so we can do better for the patient.
Is It Time to Rethink Mental Illness? (Pt. 1)
Invariably, patients will ask their chiropractor about depression or various mental illnesses. Some practitioners will reflexively offer a cervical adjustment, suggest St. John's wort or contemplate a referral to a specialist.
Clearing Blocks: A Way to Improve Cosmetic Acupuncture
As a Five Element acupuncturist who teaches facial acupuncture classes nationally, I was surprised to learn that one of the basic principles I was taught in school is unfamiliar to most acupuncturists.
Is the New Medicare Reporting Exemption Right for You?
What you've heard is not a rumor – there will be exemptions for providers of Medicare patients, with no penalties assessed for offices that do not do Quality Payment Program (EHR, PQRS, MACRA and MIPS) reporting.
News in Brief
ACA Adopts New Governance Model; ACA 2017 Awards; CCA Helps Calif. DCs "Share the Love"; $1 Million to Help Advance the Profession; D'Youville Raises the Bar on Anatomy Education; ErRatum.
Creating Good Business Buzz
What do patients really think about working with you? Rarely do you hear the whole truth. Those who improve may be candid in their gratitude.
Eczema & Acupuncture: A Sound Solution (Part 1)
Eczema affects approximately 3.5 percent of the global population and is one of the most common skin complaints seen by dermatologists.
New Relationships, Old Trauma: AOM & Other Healing Strategies
Being in love is one the most beautiful and enjoyable experiences. Most of us are willing to pay almost any price to have that experience, and still often find it elusive or fleeting. Navigating the ups and downs of loving relationships are often challenging — even for the most psychologically balanced among us.
Women's Hormones: A Western & Eastern Perspective
Sometimes it may seem that you require a degree in medicine to understand hormones and how they function.
Raditation & Your Smartphone: Is it Worth the Risk?
If radial arteries could talk (and in my experience they can to some extent), they would say, "Step away from the smartphone." At least that is the message I am receiving loud and clear as I feel the pulses of many patients.
An Integrated Approach to Chronic Pain
Findings from a unique Medicaid pilot project in Rhode Island involving high-use Medicaid recipients from two health plans were recently presented to the state's Department of Health, demonstrating stellar outcomes with regard to medication use, ER visits, health care costs and patient satisfaction.
Give Yourself the Digital Advantage
When you see this article in the print version of this issue and swear you read it already, don't be alarmed: you probably did. That's because by that time, the May issue will have been available online in digital format for three weeks.
A Daily Strategy for Heavy-Metal Detox
In modern society, we are constantly exposed to heavy metals such as cadmium, lead and mercury. These heavy metals have no essential biochemical roles in our body, and conversely, can cause us a great deal of harm if they build up to toxic levels.
Why I Quit Doing House Calls
My father was a chiropractor who did house calls, so when I became a DC, I figured doing house calls was part of the job. My March article recalled my experience as a small boy, accompanying my dad while he went to patients' homes to treat them.
December, 2006, Vol. 06, Issue 12
Tarsal Tunnel Syndrome
By Whitney Lowe, LMT
Most people are aware of carpal tunnel syndrome as a common nerve entrapment problem in the wrist and hand. There is a similar type of nerve entrapment in the ankle, which is not as common.Entrapment of the tibial nerve as it passes through a tunnel on the medial side of the ankle is called tarsal tunnel syndrome.
Nerve entrapment syndromes don't occur with as much frequency in the lower extremity as they do in the upper extremity. As a result, tarsal tunnel syndrome (TTS) is considered by some to be a rare condition, leading to it being frequently overlooked as a source of foot pain.1 The location of pain on the plantar surface of the foot produced by TTS also might cause it to be mistaken for plantar fasciitis. TTS also can be mistaken for proximal nerve compression pathologies, such as herniated discs in the lumbar region.
As the tibial nerve exits the deep posterior compartment, it passes around the medial side of the ankle on its way to termination in the toes. Near the medial malleolus, it divides into three branches. Just after it divides into these three branches, they all pass under a fascial band on the medial side of the ankle called the flexor retinaculum (Figure 1). The retinaculum is connected superiorly to the medial malleolus and inferiorly to the medial side of the calcaneus. The space under the retinaculum is the tarsal tunnel. There are several other structures that pass through the tunnel, including the tendons of tibialis posterior, flexor digitorum longus and flexor hallucis longus, and the posterior tibial artery and vein.
Tarsal tunnel syndrome results when the tibial nerve or its branches are exposed to compressive or tensile stress within the tarsal tunnel. Nerve compression occurs from pressure outside the tunnel such as a direct blow to the medial side of the ankle or from force within the tunnel from synovial ganglions or bony prominences.2,3
A swelling of synovial tendon sheaths (tenosynovitis) also could compress the tibial nerve.
Tensile forces on the tarsal tunnel nerves also cause symptoms. Neural tension results from either a sudden or chronic stretch of the nerve. Sudden nerve stretch happens in acute injuries while chronic stretching results from postural distortions such as a calcaneal valgus foot alignment.
Peripheral neuropathies like TTS can be linked to systemic disorders such as diabetes, muscular sclerosis, rheumatoid arthritis and hyperthyroidism.4 Note that some medications might cause sensitivity in the distal lower extremity nerves that could be mistaken for compression pathologies in the tarsal tunnel.
Identifying the Condition
A client with TTS reports sharp, shooting pain sensations around the medial ankle and along the plantar surface of the foot. In addition to pain, there might be paresthesia, numbness or motor weakness in the muscles of the foot. Symptoms ordinarily are worse after long periods of standing or walking, but also might be aggravated during the night if the nerve is in a compromised position for prolonged periods. Ask about recent trauma involving sudden compressive or tensile loads on the nerve, as recent injuries might be responsible for the symptoms. It's important to ask about systemic disorders that might cause TTS, or be related to it.
There are no clear visible signs of tarsal tunnel syndrome, but certain postural disorders such as calcaneal varus or valgus can aggravate the condition. Although uncommon, if TTS is severe or has been present for a long time some atrophy of the muscles innervated by the divisions of the tibial nerve might be apparent. Placing pressure directly on the tarsal tunnel is one of the most valuable ways of identifying this condition and is sometimes called the tarsal compression test. If the pressure reproduces the client's primary pain or other neurological sensations, it's a good indication of tarsal tunnel syndrome.
A special orthopedic test called the dorsiflexion-eversion test also is used to identify the condition. In this test, the client is in a supine position. The ankle is passively moved into maximum dorsiflexion and eversion while the toes are held in hyperextension (Figure 2). The position is held for five to 10 seconds. If symptoms develop, it's a positive sign of TTS.
Identifying nerve compression pathologies like TTS is important so proper treatment can be administered. If the client reports foot pain, there might be a tendency to use additional pressure around the ankle or foot in an effort to "work it out." This would be a mistake with a nerve compression pathology like TTS. Accurate identification will guide the most appropriate treatment.
Click here for more information about Whitney Lowe, LMT.
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