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Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
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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