News in Brief
A Comprehensive Model of Spine Care; Dr. Christine Goertz Appointed Vice Chair of PCORI Board of Governors.
Electrotherapy Gives Hope for Patients With Spinal Cord Injury
There has been little optimism for recovery from a spinal cord injury because the central nervous system does not repair itself well. The severity of the injury depends on the affected area.
Acupuncture is a Science-Based Medicine
A longstanding patient of mine came in for a routine treatment after she recently began seeing a chiropractor for neck pain. She saw him a couple of times and wasn't getting the relief she had hoped for, so he recommended she let him do dry needling.
The Raw Food Debate: Practitioners Discuss Nutrition & TCM
Licensed acupuncturist and fellow blogger Elissa Gonda joins this month's column for a conversation about raw food diets. She brings her perspective on the healing potential of a raw primal diet.
A Guide to CBD Dosing: The Correlation Between Dose & Potency
There is an abundance of information available about the daily use of whole plant hemp CBD oil to help maintain and support a healthy lifestyle, however there remains a lack of sound guidance on CBD oil dosing.
The Top 5 Strategies to Manage Your Reputation Online
You don't need an acupuncture website anymore! Okay, maybe that statement is a little over the top. But it's not that far from the truth. A recent study on Google searches revealed that 34 percent of all searches resulted in no clicks at all.
Map It: Understanding the Customer's Journey
One of the biggest marketing mistakes most practice owners or administrators make is not putting themselves in their prospective or current patients' shoes. How do they think and feel about you and your practice? What makes them take action?
When Computers Cause UCS: Adjusting Strategy
With the widespread use of mobile devices such as smartphones and tablets, the incidence of "text neck" has reached almost epidemic proportions. But there is another challenge to the spinal health and well-being of our technology-driven society.
Malpractice Insurance: Understanding the Cover Letter
Purchasing medical liability insurance is quick, easy and not terribly expensive. The benefits are clearly listed on a certificate—but do you really know what you are getting with that peace of mind?
2018 Gallup-Palmer Report: Key Findings
The fourth annual Gallup – Palmer College report is out; here are some of the key findings excerpted directly from the executive summary regarding Americans' experiences with chiropractic care relative to the management of neck and back pain:
Bad for the Back! Exercises That Can Prevent Healing
The questions "Who gets well? Who doesn't? Why?" prompted the following observations based on my close to 40 years of chiropractic practice.
Year in Review: DC's Best of the Best for 2018
As 2018 winds down, let's highlight the most popular articles in Dynamic Chiropractic by month (December – this issue – excluded, of course).
The Truth About Malpractice Claims Against DCs (Pt. 1)
Over the past 20 years of active practice, I have seen a number of scary case scenarios regarding signs, symptoms and patient presentations in my office. These presentations scream, This patient is going through an event or This patient does not need chiropractic care, they need emergency care.
VA Choice Claims Denied? Here's How You Can Get Paid
The VA Choice Program (PC3 as well) indeed pays for chiropractic care including manipulation (CMT 98940-98943) and some physical medicine services.
Knocking Down the Doors: Big Media Success for F4CP
Three articles authored by a DC or a chiropractic organization and promoting the value of chiropractic care – par for the course if you're Dynamic Chiropractic, but if you're Forbes, BOSS Magazine and Becker's Spine Review, three media outlets tailored toward high-level executives and decision-makers, we're talking about an entirely different story.
VA Chiropractic Reduces Veterans' Use of Opioids?
Utilization of pain medication – particularly opioids – has been massively high in among veterans for decades, but Veterans Administration guidelines that recommend nonpharmacological first-line treatment options create a greater opportunity than ever for VA chiropractors to make a dent in the opioid and overall pain-management crisis.
Dietary Supplements That Help Restless Leg Syndrome
It is estimated that 7-10 percent (possibly up to 15 percent) of the U.S. population has restless leg syndrome. It is a bit more common in women than men.
A Soy Isoflavone That Packs a Punch: Genistein
Soybeans contains unique substances called isoflavones, most notably genistein and daidzein, which have been shown to block the buildup the dangerous type of testosterone in the prostate gland linked to prostate enlargement and prostate cancer.
A Simple Miracle: Treatment for Mysterious Foot Pain
Under the old ICD-9 diagnosis codes, there was actually a diagnosis for "adventures in medical mismanagement" to describe patients who had been run down the rabbit hole of poor case management and care. I encountered one of those patients in my office today.
Reality Check: Do We Need to Try Harder?
While waiting for a flight to a recent chiropractic event, I overheard the ticket agent at the gate next to mine on his cellphone. His side of the conversation went something like this: "Where are you now? How long before you think you can be at the gate? OK, that will work, see you soon."
Reaching for Our Roots: Healing Digestion With a Simple Traditional Therapy
Are you ignoring a powerful tool in your doctor's bag? Many acupuncturists realize that Spleen Qi deficiency has reached epidemic proportions in the U.S. Yet, we don't prioritize educating our patients about the importance of warm, cooked foods.
Goodbye, Year of the Dog: Two-Thousand-Eighteen Comes to a Close
As Year of the Dog (2018) comes to a close we can look back and see the progress this profession has made. For example, the International Classification of Diseases (ICD) added traditional medicine codes, which were released in June.
A New President for AOMA: A Conversation With Mary Faria
Dr. Faria was formerly a health care executive for over 30 years, the last 17 of those years as vice president and chief operating officer of Seton Southwest Hospital in Austin. She chairs the board of Austin Mayor's Health and Fitness Council.
Acupuncture in Hospital Systems: Transitioning From Tolerated to Celebrated
I've had the pleasure of working with Susan Luria, Director of University Hospitals Health Systems Connor Integrative Health Network (CIHN) for the past year on the Integrative Health Policy Consortium (IHPC) Board of Directors and Federal Policy Committee.
Cynicism and Burnout: It Can Happen to You
Trying to achieve fulfillment as a doctor in today's health care environment is a "rigged game" and physicians are programmed to burn out. At least this is the opinion of Dike Drummond, MD, in his thehappymd.com blog.
ACA Champions H.R. 7157; ICA Voices Major Concerns
While the American Chiropractic Association recently penned an open letter – signed by not only the ACA, but also the Congress of Chiropractic State Associations, Association of Chiropractic Colleges, Clinical Compass and a number of state associations.
July, 2006, Vol. 06, Issue 07
Pain Under the Medial Arch of the Foot
By Ben Benjamin, PhD
Question: If a person experiences pain under the medial arch of the foot while walking or while rising onto the balls of the feet to reach for something, which structure is likely to be injured?
Answer: The flexor hallucis.The flexor hallucis is a very strong muscle-tendon unit that takes the lion's share of our weight while we walk, stand and rise onto the balls of our feet. The muscle is located in the calf, and its tendon begins just medial to the Achilles' tendon. The tendon passes under the medial heel and travels along the medial arch of the foot to attach distally at the great toe.
Poor alignment makes the flexor hallucis tendon more susceptible to injury. In a normally aligned foot, roughly one-third of the body's weight falls onto the great toe, with one-sixth falling onto each of the other toes. If the feet are turned out while standing and walking, even more weight falls onto the great toe - and therefore onto its flexor tendon. In such cases, strain or tendinitis of the flexor hallucis tendon is fairly common. In cases where poor alignment is placing pressure on the medial arch, there often is a callus at the medial edge of the great toe and/or the medial aspect of great toe joint.
Flexor hallucis injuries occur most commonly in the medial arch of the foot. Injuries to the flexor hallucis tendon at the back of the ankle, where the tendon is running parallel to the Achilles', are sometimes mistaken for Achilles' tendinitis. Injuries to this tendon near the anterior portion of the heel often are mistaken for plantar fasciitis. If a person feels pain not just at the medial arch, but in a wider area under the arch of the foot, this might indicate that the flexor tendons of several other toes also are strained or that a plantar fasciitis is present.
Question: What assessment test would you perform to verify this injury?
Answer: Resisted plantar flexion of the great toe.
First, hold the great toe in slight dorsiflexion (Figure 1) with your thumb and ask the person to push the toe down against you (into plantar flexion). If the injury is relatively severe, this test will be positive (causing a little pain). If the tendon is only mildly strained, you'll need to perform one or two additional tests to place more stress on the tendon.
The second test is performed in a standing position. While holding the client's hands for balance, ask the person to rise onto the balls of the feet (Figure 2). If this reproduces the person's pain, and the pain is in the medial arch, you have confirmed the presence of flexor hallucis tendon strain. If the reproduced pain is in the Achilles' area, you'll need to do further testing to determine whether it's coming from the Achilles' or the flexor hallucis. If this second test does not cause discomfort, move on to the third test.
For this final test, have the client face a wall and lean against it at approximately a 35-degree angle, while rising up onto the balls of the feet (Figure 3). If this causes no pain or discomfort in the offending area, ask the person to transfer most of his or her weight onto the big toes. This places maximum stress on the flexor hallucis tendon.
Click here for more information about Ben Benjamin, PhD.
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