resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Help Patients Achieve Optimal Vitamin D Levels
Much research has been done on vitamin D levels and their impact on health; optimal levels have been correlated with a reduced risk of developing numerous conditions.
Saying No to Medicine
An interesting article recently appeared in Men's Journal titled "When to Say No to Your Doctor." The article begins with the summary statement above and effectively arms readers with information that will help them "take more responsibility for your own health care, because you can't be sure anyone else is.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
5 Ways to Occupy Occupational Health
Despite the progress that has been made to better protect workers, occupational health and safety remains a priority area for many national governmental organizations due to the widespread problem of occupationally related morbidity and mortality.
Blaming the Gluteus Medius, Overlooking the Deltoid
The gluteus medius (Gmed) is commonly written about, strengthened and blamed for many conditions, and rightfully so. After all, the Gmed plays a role in pelvic stability, hip motor control and lower-quarter dynamic movements.
Understanding and Identifying Pediatric Growth-Plate Fractures
In general, fractures in children heal well with little intervention as long as the alignment is good. Fractures involving the growth plate, however, are a different issue. In fact, growth-plate injuries are the primary reason for the subspecialty of pediatric orthopedics.
Talking to Patients About Healthy Aging
I've noticed that a particular category of patients seems to make up more and more of my practice – they work out, but still experience lots of degenerative joint disease (DJD) issues.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Transparency and Accountability: Q&A With the CCE
Every profession needs an organization dedicated to upholding the quality and integrity of its degree programs and educational institutions.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Web Marketing: Content Is King
Google's sweeping updates to its search algorithms over the past few years have brought a paradigm shift in how you can optimize your chiropractic website to gain maximum marketing leverage.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
The X Factor in Clinical Research: The Patient
It was the great baseball legend, former New York Yankees catcher Yogi Berra – he of countless aphorisms, each with a mind-bending twist – who once declared, "You can observe a lot by watching."
September, 2013, Vol. 13, Issue 09
When Feet Take a Beating: Working with Morton's Neuroma
By Whitney Lowe, LMT
Foot pain is a common occurrence in our society. Whether it is standing all day on your job or giving your feet a serious challenge by running long distances on pavement, the feet certainly can take a beating.Most everyone would agree that it feels great to get your feet massaged and massage therapy can be an excellent tool for addressing many foot pain complaints. However, there are foot pain conditions that require special consideration and for which some methods of massage are not advised. Morton's neuroma is a moderately common foot complaint. While some methods of massage are helpful in addressing the complaint, other massage techniques can aggravate the condition and perpetuate the dysfunction.
A neuroma is an inflamed or irritated nerve. Morton's neuroma is a nerve compression that causes pain in the forefoot and toes. The condition is also called Morton's metatarsalgia or interdigital neuroma.
The primary structures causing pain and dysfunction in Morton's neuroma are the medial and lateral plantar nerves. The plantar nerves are an extension of the tibial nerve, which itself is a division of the sciatic nerve. As the tibial nerve passes through the tarsal tunnel on the medial side of the ankle, it divides into the medial and lateral plantar nerves. Both nerves course along the plantar surface of the foot and terminate in the toes. The medial plantar nerve supplies sensory innervation for the first through the third digits, while the lateral plantar nerve supplies the fourth and fifth. Morton's neuroma involves compression of the medial or lateral plantar nerves as they pass between the metatarsal heads (Figure 1).
Morton's neuroma presents with greatest frequency between the third and fourth metatarsal heads because the space between the metatarsal heads is smallest here. The condition can occur between any of the metatarsal heads, but is most likely between the third and fourth. The second most common location is between the second and third because the space between them is also relatively narrow.
Morton's neuroma develops for several reasons. The primary reason is wearing narrow toe-box shoes, which compress the metatarsal heads. Certain anatomical factors also make nerve compression more likely with the narrow toe box shoes. In some people fibers, the medial and lateral plantar nerves converge close to the heads of the third and fourth metatarsals. This junction creates a larger nerve structure between the metatarsal heads making it more vulnerable to compression.
Tensile stress on the nerve during foot motions is also a factor that leads to Morton's neuroma. The toes are in hyperextension at the very end of the push-off phase during walking or running gait. This extended toe position is also exaggerated by high heel shoes. During toe hyperextension, the nerve is pulled taut against the transverse metatarsal ligament, which is deep in the foot and connects adjacent metatarsal heads (Figure 2).
Sometimes, a previous injury, such as a fracture or ligament damage, can produce scar tissue that reduces the space between the metatarsal heads. Scar tissue can also bind the nerve to adjacent structures, including the ligament, impairing proper movement of the nerve.
The primary symptoms include sharp, shooting pain, numbness or paresthesia in the forefoot and extending distally into the toes, typically in the region of the third and fourth toes. Symptoms are aggravated with narrow toe box shoes or those with high heels. There is usually a reduction of symptoms when walking barefoot or wearing shoes with an appropriately wide toe box. Symptoms are also aggravated with shoes that are tied too tight.
There may be pain at the end of the push-off phase when walking or running, and this pain is generally worse when the client is wearing shoes as opposed to being barefoot. Clients may also report a relief of symptoms by massaging the foot, which may spread the metatarsal heads and mobilize the entrapped nerve.
Accurately Identifying The Complaint
In addition to the signs and symptoms described previously, there are physical examination methods that may help identify the presence of plantar nerve entrapment in the forefoot. During range of motion evaluations, pulling the toes in hyperextension and dorsiflexing the foot at the same time may produce symptoms if the condition is advanced.
There is a special orthopedic test called the Morton's test that is often used to evaluate the likelihood of plantar nerve compression. For this test, the client is supine on the treatment table. The practitioner grasps the client's forefoot from both sides and applies moderate pressure, squeezing the metatarsal heads together (Figure 3). If this action reproduces the client's symptoms (primarily sharp, shooting pain into the toes, especially the third and fourth), Morton's neuroma may exist.
The most important factor in the treatment of Morton's neuroma is changing footwear. Sometimes a cushioned dome pad can be worn inside the shoe and this helps spread the metatarsal heads and decrease pressure on the nerve. There are other products that can be worn between the toes with certain types of shoes or when the client is barefoot. These toe spacers will help reverse biomechanical patterns that aggravate the nerve compression.
Massage can be helpful, but should not be performed with deep pressure between the metatarsal heads. Additional pressure in this region can aggravate the nerve compression and prolong the pathology.
The best results are achieved with massage techniques that encourage spreading and mobilizing the metatarsal heads. Metatarsal spreading is one technique that can help reduce the detrimental effects of nerve compression. To perform this technique, pull the metatarsal heads (not just the toes) apart and hold them in this position to help stretch the intrinsic foot muscles and other soft-tissues. When this technique is combined with the use of toe spacers, it will be even more effective.
It can also be helpful to perform deep stripping massage techniques along the length of the tibial nerve and the medial and lateral plantar nerves. After properly mobilizing these tissues, moving the foot and toes through a full range of motion to make sure the nerve can move freely will also be helpful.
Foot pain like that occurring in Morton's neuroma, can become a debilitating and painful condition. And while massage can be helpful for this condition, it is also clear that improperly applied massage can aggravate it and make it worse. Consequently it is crucial that we use good clinical reasoning and appropriate evaluation methods to most effectively help these clients.
Click here for more information about Whitney Lowe, LMT.
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