Massage & Bodywork

MAY | JUNE 2023

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My new client was a college student who injured his foot playing club soccer. At one point, he was about to kick the ball and misjudged the trajectory, hitting the ground first, putting his toe into hyperflexion and immediate pain. He sat out for the next few minutes but was able to resume his participation and played the remainder of the match. The real trouble started later. "Later that evening, my big toe really started to hurt," he said. "Walking became difficult, and I got more concerned I might have broken something. After visiting the campus medical center, the doctor sent me to get an X-ray to see if everything was OK. The doctor said the X-ray looked negative. If it was OK, why the heck does my foot hurt so much? It's more than just my toe now; I can feel it higher up my leg, which I didn't feel earlier. That's kind of scary." "Let me take a look and perhaps I can give you some answers," I said. Having him lie supine on my treatment table, I noted no obvious swelling at the metatarsophalangeal joint. The range of motion was good in terms of total movement, but the quality of movement drew my attention. Taking the toe into f lexion, I could feel his extensor muscles slightly engage, making the movement somewhat hesitant. "Want to see a picture?" he asked, somewhat out of the blue. "Sure," I said. He found a picture on his phone of the metatarsophalangeal joint two days after the injury. The bruising was impressive. As I was about to ask another question, he added another wrinkle. "You know, it's strange, but when I did this, pain wasn't the first thing I felt," he said. "What was?" I asked. "I felt like my whole toe went numb," he said. "That was concerning to me; I expected it to hurt like crazy. Instead, it was a numbness from my toe to the top of my foot. It is still kind of weird feeling." critical thinking | TABLE LESSONS Toe-ing the Line of Pain By Douglas Nelson 82 m a s s a g e & b o d y wo r k m ay/ j u n e 2 0 2 3

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