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L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 23 through the metatarsals until you have worked each of the four joint spaces (scan "Metatarsal Mobilization" QR code). 9. Neural Mobilization: Tibial Nerve Neural mobilization techniques apply a gentle tensile load on the affected nerve, along with dorsifl exion and plantar fl exion movements. This action can encourage movement in the nerve where it may be compressed or compromised through narrow channels. Mobilization can affect the tibial nerve branches that extend down into the foot. To perform, pull the foot into simultaneous dorsifl exion with toe extension (adding neural tension). Then move the foot into plantar fl exion (reducing the tensile load). Knee extension and hip fl exion can be added into each stretch to enhance the effect but can add discomfort, so check in with the client (scan "Neural Mobilization: Tibial Nerve" QR code). CONDITIONS The techniques described before address a variety of foot pain complaints discussed in the fi rst installment of this series. However, it's important to remember that no technique will work in every situation. Below are guidelines to consider for each condition. Plantar Fasciitis With plantar fasciitis, the client is likely to report pain when fi rst putting weight on the foot in the morning. If the onset is recent or the pain is not severe, treatment may be more aggressive or use more signifi cant pressure. However, keep pressure levels within the client's comfort tolerance. There may be compensatory tightness in the intrinsic foot muscles or the leg muscles, such as the tibialis posterior, which extends into the foot. So, it is beneficial to address the long muscles of the lower leg that extend into the foot near the plantar fascia. The condition is likely to be considerably more painful in the later stages. As a result, treatment choice should be less intensive at the outset. Adjust pressure levels accordingly, and avoid aggravating the client's pain. A primary concern at the later stages of the condition is that chronic ongoing pain may increase neural sensitization (increased sensitivity of the sensory nervous system). Sensitization may gradually cause hypersensitivity and pain in other areas of the foot and lower leg. To address sensitization, general relaxation massage techniques throughout the lower limb are beneficial, even if they do not target the plantar fascia itself. Beneficial techniques: 1, 2, 3, 4 Nerve Entrapment Tarsal Tunnel Syndrome and Baxter's Neuropathy: The treatment goal for both conditions is to relieve pressure on the affected nerve(s). The primary problem involves nerve compression, so avoid techniques that put additional pressure directly on the nerves on the medial side of the ankle or bottom surface of the foot. The best treatment approaches are indirect. A key strategy is to address tightness and irritation in the soft tissues contributing to biomechanical distortion or nerve compression. Three tendons from the muscles in the deep posterior compartment can compress the tibial nerve in the tarsal tunnel area: tibialis posterior, f lexor hallucis longus, and f lexor digitorum longus. Massaging the tendon is not likely to accomplish much, but working on the contractile elements of the muscle in the deep compartment can help tarsal tunnel syndrome. This is an instance in which remote work away from the tarsal tunnel is beneficial. In the early stages of tarsal tunnel syndrome and Baxter's neuropathy, treatment can focus on the biomechanical factors leading to the nerve entrapment. Effective treatments address the leg's superficial and deep posterior compartment muscles and soft tissues on the foot's plantar surface. These lower-leg muscles can impair Understanding foot pathologies and recognizing their key signs and symptoms allows us to intervene earlier. VIDEO: "METATARSAL MOBILIZATION" 1. Open your camera 2. Scan the code 3. Tap on notification 4. Watch! VIDEO: "NEURAL MOBILIZATION: TIBIAL NERVE" 1. Open your camera 2. Scan the code 3. Tap on notification 4. Watch! TECHNIQUE