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the fl exor digitorum brevis and the quadratus plantae muscles in some cases (Image 5, page 99). It is challenging to identify compression of the ICN with physical examination. However, a few methods may help determine the possibility of this nerve's involvement. Pain elicited with palpation along the arch on the bottom surface of the foot is usually present. In some cases, pain with palpation will be exaggerated along the lateral aspect of the plantar surface where the ADM muscle is located. Pain may also be elicited with palpation along the medial arch where the nerve is likely to be entrapped. The fl exor digitorum muscle is not always innervated by the ICN, but when it is, there may be weakness of this muscle that is apparent with resisted fl exion of the last four toes. One way to examine this is to place a thick card, like a business card or standard 3" x 5" index card, on the ground. Have the client attempt to hold the card down with all four toes as you attempt to slowly pull it out (Image 6). If they are unable to hold the card, or if it appears easier to pull the card away than when the same procedure is performed on the other foot, there is likely weakness in the fl exor digitorum brevis muscle. This may indicate potential compression of the ICN. One of the more accurate methods of determining involvement of this small nerve is with an MRI. 3 When motor fi bers to the ADM muscle are damaged, the muscle will atrophy and fatty edema can build up in the muscle. The fatty infi ltration of muscle is visible on the MRI. Because it is so diffi cult to identify the clinical indicators of ICN compression through physical examination, this nerve compression pathology is often missed if an MRI is not performed. Baxter's neuropathy is likely to occur in conjunction with other foot pain problems, making its presence more diffi cult to identify. One study found a strong correlation between ICN compression and three other key factors: calcaneal bone spurs, increased age, and plantar fasciitis. 4 It may also result from certain biomechanical challenges in the foot, such as pes planus (fl at foot). 5 TREATMENT STRATEGIES As with all nerve compression problems, it is important that treatment does not aggravate nerve irritation, as it could make the condition worse. Communicate closely with your client as you work to make sure symptoms aren't 100 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 6 Dive into training that takes you to new depths of learning Go beyond the surface! orthopedic massage Whitney Lowe's Online Training & Certi cation Personalized instruction from Whitney Lowe Interactive & dynamic learning activities Extensive video library with ongoing access Free clinical news & research newsletter Free CE sample courses "...the best course I've taken in 30 years of CE." "...one of the very best teachers I've had in the business." "...what an incredibly useful & accessible course!" Academy of clinical massage www.academyofclinicalmassage.com 866-744-8456 Training excellence in science-based clinical massage for over 2 decades. Workshops: GA, DE, TX, CT, CA, ID www.acmspecials.com save on courses, books, workshops Specials