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90 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 7 Clients are likely to report aggravated symptoms when they wear specifi c shoes, especially those with a narrow toe box. These symptoms may also increase when wearing shoes that are laced tightly. Because of the tensile stress on the nerve during toe extension, it is also common for symptoms to be increased when ascending or descending stairs. Nerve compression problems can be challenging to confi rm through diagnostic testing. Highly precise diagnostic imaging like an MRI can show the spatial relationship between adjacent structures, such as whether a nerve is close to a bone. However, this imaging does not necessarily indicate that nerve compression exists. In these cases, clinical evaluation is the most effective method for accurately identifying the problem. Numerous studies have indicated that a complete and thorough clinical examination is more effective than an MRI in identifying the presence of digital nerve compression in Morton's neuroma. That is good news for massage therapists because it emphasizes that accurate assessment of the tissues involved (nerves) can be determined without the need for an MRI or other high-tech imaging. In addition to the specifi c clinical symptoms that might point to digital nerve entrapment, there are additional evaluation procedures that may be helpful in assessing these symptoms. Because the nerve is deep in the foot and located directly between the metatarsal heads, it is not feasible to reproduce symptoms through superfi cial palpation only. The following special evaluation procedures are designed to apply stresses on the plantar digital nerve branches that should reproduce symptoms if the nerves are being pathologically compressed or irritated. 4 Interdigital squeeze test. 5 Morton's test. Example of a "foot-shaped" shoe from Altra. 6 The interdigital squeeze test is one of the most commonly used procedures for identifying plantar digital nerve entrapment. One fi nger is placed on the dorsal surface of the foot in the space between the suspected metatarsals (usually between the third and fourth). The thumb is placed on the bottom surface of the foot (Image 4). The two fi ngers are squeezed together with a moderate amount of pressure. If this reproduces sharp neurological sensations into the toes, this is a good indication that the digital nerves are entrapped. The Morton's test is another commonly used procedure for assessing nerve entrapment between the metatarsal heads. In this procedure, the practitioner places the palm of one hand on the medial side of the client's foot near the MTP joint. The other hand is placed on the lateral side of the foot at the fi fth digit MTP joint (Image 5). The practitioner then applies a moderate amount of pressure by squeezing the hands together. Make sure not to curve the transverse arch, but instead press the metatarsal heads directly toward each other and keep them in alignment. If symptoms are reproduced with this pressure, which mimics that of a narrow toe-box shoe, there is a good chance that digital nerve compression is involved. TREATMENT STRATEGIES The most important goal in addressing any nerve compression problem is to remove or lighten the pressure on the nerve. Tissue healing will generally occur as long as the aggravating biomechanical forces (compression or tension) are removed. The most common strategy used is changing footwear away from narrow toe-box shoes to give the foot more room to spread out inside the shoe.