resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Healing With Simple, Healthy Food
When it comes to your health, there is no better way to take control and create positive outcomes than by focusing on diet and lifestyle. As chiropractors, you know the power that regular self-care has for your patients.
Getting Athletes Back in the Game: Low-Level Laser Therapy for Sports Injuries
Sports injury rehabilitation is all about getting back in the game quickly and with optimal health. A relatively new tool for the treatment of sports injuries is finding global success, and it is doing so in a fast, efficient way.
Looking Back: Abstracts From Chiropractic History
D.D. Palmer's Technique for the Posterior Apical Prominence; An Early Attempt to Achieve Consensus on Subluxation; Chiropractic Subject Headings: Past, Present and Future; Mabel Palmer: A History of Chiropractic That Almost Wasn't.
Offline Marketing Techniques: Opportunities to Help Grow Your Business
In a world becoming increasingly dominated by connected devices, when we think of marketing, we often think of online and social media marketing. Considerable attention is given to Facebook and Twitter, as well as CPC [cost-per-click] advertising.
Advice for Young Doctors
When I began practice, I was just shy of my 25th birthday. I was young and I looked it. I had been told this would be a problem when starting a practice – and it was. Older patients often paused when they entered for care.
Medical Qigong for the Heart: Part II
Chinese Medicine is rich in commentary regarding the emotions and how they affect our qi.
Best Practices for Website Success
If one asked 10 years ago whether a website was relevant I was the first to suggest no. Yet as the world moves increasingly towards electronic information there is a dire need to have a website for your practice. Your website is actually your electronic calling card.
F4CP: New Campaign to Promote Chiropractic as a Career
The F4CP has announced a "targeted cooperative campaign" that will engage doctors of chiropractic and chiropractic students, as well as chiropractic colleges, chiropractic media, state associations and vendors, to encourage DCs to recommend a chiropractic career to patients, family and friends.
Post-Concussion Patient Care: Relevance of the Chiropractic Adjustment
There is a widespread understanding within the profession of the general guidelines for care of the concussion patient. These include guidelines for physical and cognitive rest, return to normal activities and so forth.
The Acupuncture Success Express
Time is passing very quickly these days. We are atoms half the way through the year of the horse. You could call it "horse racing season" for this profession. Perhaps it is time for reinvention during this time.
Talking to Skeptical MDs: "Just the Facts, Ma'am"
The first lesson in public speaking is to know your audience. This is particularly applicable when talking to skeptical medical doctors about chiropractic. You have to understand where they are coming from and speak the language they understand.
Spotlight on Acupuncture Research at IRCIMH
Acupuncture and Traditional Chinese Medicine were well-represented at the International Research Congress on Integrative Medicine and Health (IRCIMH)- 2014 which took place in Miami from May 13–16.
Healing With Hope
Ella is a Gulf War veteran and a survivor of military sexual trauma. Like hundreds of veterans, Ella was on 11 different medications for depression, anxiety, insomnia, irritable bowel syndrome and chronic pain.
The Kidney Official
The Kidney is known as the Official Who Controls the Waterways. In Western medical terms, a major function of the Kidneys is to filter the blood. Every day, a person's kidneys process about 200 liters of blood to sift out about two liters of waste and excess water.
Hazards in the Environment Making Your Patients Sick
Working both separately and together, Western and Chinese medicine have many successes in the treatment of the myriad diseases that afflict human beings in modern times.
Super Bowl Chiropractor
With opening night of the 2014 National Football League season only a month away, what better time to talk to Dr. Jim Kurtz, team chiropractor for the defending Super Bowl champion Seattle Seahawks?
Deciphering The New CMS 1500 Claim Form
Q: I am confused on using the new 1500 form, particularly Block 14 and Block 15. What is required and how do I properly fill these out? And do I actually have to use this new form or may I continue using the old version?
Looking For Answers In Many Places
I am sure we have all heard the old adage: "When the only tool in your toolbox is a hammer, everything starts to look like a nail."
Resolving Medial Arch Suspicions: The Navicular Drop Test
Healthy feet have three distinct arches: medial longitudinal, lateral longitudinal and anterior transverse.
Inside Liver Failure, Cirrhosis and Cancer
The Liver belongs to Wood in Five Element Theory and is in charge of Dispersing and Expanding which means all the processing and detoxifying of harmful substances such as medications and chemicals require the efforts of the Liver.
Primary Lateral Sclerosis: A Condition With a Chiropractic Connection
Primary lateral sclerosis (PLS) is a slowly progressive, adult degenerative disease of the upper motor neurons characterized by progressive spasticity or stiffness. It is a clinical diagnosis that has been avoided because it is (largely) a diagnosis of exclusion.
Not Another Typical Drug Company Lawsuit
It's becoming more common to see drug manufacturers negotiate "false claims" settlements for millions and billions of dollars.1-2 Most of these settlements have to do with violations in the marketing of the drugs they produce and sell.
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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