Issue link: https://www.massageandbodyworkdigital.com/i/766890
C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 91 Some footwear companies are now recognizing the importance of shaping the shoe to meet the structural needs of the foot. An example is the Altra running shoe shown in Image 6. This larger toe box not only decreases compression on the metatarsal heads, but also allows more room in the shoe for other therapeutic devices, such as domed pads, which are often placed underneath the metatarsal heads to help spread the digits apart. There are other products like YogaToes and Correct Toes 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. Don't underestimate the value of a relatively simple treatment like changing footwear. When nerve tissue gets aggravated, it can cause an increased degree of sensitivity throughout the entire nervous system and may become a self-perpetuating problem. A relatively simple problem like Morton's neuroma can develop into a more problematic and long-lasting condition, with more severe nerve irritation distributed throughout the affected nerves and their trunks. Traditional medical treatments generally focus on reducing the irritating symptoms so the nerve does not continue to increase in sensitivity. Corticosteroid and anesthetic injections are common methods used to address the nerve compression symptoms. However, if the biomechanical factors that led to this condition are not addressed, simply attempting to reduce the pain through medication alone will have only limited or short-term effectiveness. Other traditional medical treatments include shockwave therapy, capsaicin applications, physical therapy, or surgery if none of the more conservative treatments are successful. Surgical procedures involve excision (cutting) of the plantar digital nerve. Cutting this nerve will reduce the pain sensations but will also have the adverse effect of significant loss of sensation in the toes, which could result in other problems. SCIENCE OF NERVES 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. Practitioners should also be careful when stretching the toes in extension to ensure that symptoms are not aggravated. The best massage results are achieved with techniques that encourage spreading and mobilizing the metatarsal heads. Metatarsal mobilization 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 (Image 7). Move the metatarsals back and forth in this position to help encourage mobility. When this technique is combined with the use of toe spacers like the ones mentioned above, it will be even more effective. This technique can also be viewed at www.vimeo.com/191572972. Techniques like metatarsal spreading or joint mobilizations that encourage full freedom of movement of the metatarsals are definitely helpful. Long-lasting results are unlikely with just a single soft-tissue treatment intervention, though; multiple applications are recommended. Also, keep in mind that the condition likely developed from ongoing compressive forces on the forefoot. Just helping spread those metatarsals or relax the foot muscles is a big key, but the biomechanical problem that led to the condition in the first place must be addressed and reversed. Therefore, changing footwear or addressing the constant biomechanical metatarsal head compression is key as well. It is easy for a condition like Morton's neuroma to be misidentified as other problems like sciatic nerve pain or plantar fasciitis. The most effective treatments need to be properly coordinated with the nature of tissue dysfunction. The practitioner who is able to identify the key biomechanical characteristics and symptom patterns associated with plantar digital nerve entrapment will be far more successful in helping resolve these issues with their clients. Notes 1. S. Jain and K. Mannan, "The Diagnosis and Management of Morton's Neuroma: A Literature Review," Foot & Ankle Specialist 6, no. 4 (June 2013): 307–17, doi:10.1177/1938640013493464. 2. M. Pecina, A. Markiewitz, and J. Krmpotic-Nemanic, Tunnel Syndromes: Peripheral Nerve Compression Syndromes (Boca Raton: CRC Press, 2001). Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His texts and programs have been used by professionals and schools for almost 30 years. Learn more at www.academyofclinicalmassage.com. Metatarsal mobilization and spreading technique. 7