Issue link: https://www.massageandbodyworkdigital.com/i/108504
Myofascial techniques The Intermetatarsal Space Technique. With a static touch, work between each pair of bones from both above and below, as if touching the fingers and thumb together through the foot. Once tissue has responded, ask for slow toe and ankle movement. Images courtesy Advanced-Trainings.com. Used by permission. 7 touch release, followed by active movement, in several places along each metatarsal space, and then between all other pairs of foot rays, for both feet. In some people, the narrowing of the metatarsals can irritate and enlarge the perineurium (the outer connective tissue layer) of the intermetatarsal branches of the plantar nerve (Image 9), causing foot pain or numbness. This condition, known as Morton's neuroma, most commonly occurs between the third and fourth metatarsals, right where the medial arch meets the lateral arch. If your client complains of numbness or a sharp pain between the distal ends of the metatarsals, especially when standing or wearing shoes, work to separate and decompress the intermetatarsal spaces. As long as it is within your client's comfort range, gentle but deep work here can help ease the effects of midfoot narrowing and compression, as well as address the connective tissue fibrosity of the perineurium and surrounding tissues. Use your client's active toe flexion and extension to glide the tissues under your fingertips; feel for an increase in boney mobility and openness of the intermetatarsal space. Your client may experience rapid relief, but don't be discouraged if it takes several sessions before the irritation subsides. Stubborn cases merit a change of footwear and/or evaluation by a medical professional. Conventional nonsurgical treatments include orthotics, orthopedic pads, or sclerosing or other injections. Just like people, not all feet are the same. Barefoot running isn't for everyone, and what works for one client may need to be adapted or avoided for another. We'll be most effective as practitioners if we bring the desired qualities of adaptability and flexibility to our own strategizing as well. After all, as psychiatrist Carl Jung said, "The shoe that fits one person pinches another; there is no recipe for living that suits all cases." 9 8 Notes 1. For more images and information about foot-binding, see www.environmentalgraffiti. com/news-foot-binding. 2. M. Boozer et al., "Investigation of the Relationship Between Arch Height and Maximum Pronation Angle During Running," Biomedical Sciences Instrumentation 38 (2002): 203–7. 3. A. Stacoff et al., "The Effects of Shoes on the Torsion and Rearfoot Motion in Running," Medicine and Science in Sports and Exercise 23, no. 4 (1991): 482–90. 4. K. D'aout et al., "The Effects of Habitual Footwear Use: Foot Shape and Function in Native Barefoot Walkers," Footwear Science 1 (2009): 81–94. 5. H. Menz, "Alternative Techniques for the Clinical Assessment of Foot Pronation," Morton's neuroma, a painful fibrotic enlargement of the nerve's connective tissue sheath, is one symptom associated with crowding of the metatarsals. Image courtesy Primal Pictures. Used by permission. Journal of the American Podiatric Medical Association 88, no. 3 (1998): 119–129. Til Luchau is a member of the AdvancedTrainings.com faculty, which offers distance learning and in-person seminars throughout the United States and abroad. He is also a Certified Advanced Rolfer and has taught for the Rolf Institute of Structural Integration for 22 years. Contact him via info@ advanced-trainings.com and AdvancedTrainings.com's Facebook page. ABMPtv.com "Working with the Shoe-Bound Arch" Watch Til Luchau's technique videos and read his past Myofascial Techniques articles in Massage & Bodywork's digital edition. The link is available at www.massageandbodywork.com, at ABMP.com, and on AdvancedTrainings.com's Facebook page. www.abmp.com. See what benefits await you. 117