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Advice for case of plantar neuropathy

Discussion in 'Biomechanics, Sports and Foot orthoses' started by issy1, Apr 26, 2010.

  1. issy1

    issy1 Active Member

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    A 20 year old male arrived in my clinic today complaining of pins and needles sensation in plantar aspects of both feet made worse by walking/standing and relieved by resting. He purchased a pair of full length ProThotics on internet which he says have helped 40%.

    He had a back injury 4-5 months ago ("two slipped disc in lower back") and the pins and needles sensation started in his feet about 2 months ago. He never suffered from any radiating numbness or sciatica from back injury.

    I only had a small time slot today so did a few quick tests and asked him to come back for full bio. next week. He had laterally deviated STJA, high supination resistance esp. left, low gear propulsion, lateral forefoot overload, positive jack's test and callous 2-5th MPJ I think - would need to check.

    My initial thought was he may have tarsal tunnal syndrome - but this is usually unilateral and on more pronated foot type is it not?? I am wondering if I am waisting this young man time and that foot numbess is being caused by previous back injury rather than poor foot function and would be better referred back to physio. - but since the ProThotics helped somewhat I thought perhaps orthotic therapy would help although the high supination resistance with the laterally deivated STJA is throwing me alittle, especially since the ProThotic helped. Shouldn't supination resistance be low with laterally deviated STJA?

    Would appreciate anyone thoughts or advise
  2. issy1

    issy1 Active Member


    It later came to me that he did say he occasionally feels abit of tingling at the backs of his knees. Sorry for leaving this out.

    Depends whether the peroneal's are firing / in spasm when you are doing the test. Also depends on how accurately you assessed the position of the STJ axis, patient body weight etc.

    Slump test? Straight leg raise? Tinel's sign?
  4. issy1

    issy1 Active Member


    I am quite certain that the STJA is laterally deviated in both feet. I have only done the supination resistance test however a few times now but I struggled to supinate the feet especially left.

    Does the Slump Test and Straight leg raise test for nerve entrapment in spine in which case if this is whats happening would you expect the pins and needles sensation in his soles to be brought on by these tests?

    Did not do Tinel's sign but will do.

    Simon - With above history what would be your first thought of diagnosis?

    Sounds like a nerve entrapment but you need to determine at what level.
  6. RobinP

    RobinP Well-Known Member

    Sounds like lateral plantar nerve entrapment. Results of the slump/SLR tests should be interesting though

  7. issy1

    issy1 Active Member

    He does occasionally get tingling sensation behind the knees though - would this not suggest possible entrapment at a higher level?
  8. Yes, like I said, you need to determine the level.
  9. RobinP

    RobinP Well-Known Member

    Yes, hence the results of the SLR /slump test being interesting

    Keep us posted

  10. issy1

    issy1 Active Member

    Update - Slump test brought on severe pain down legs and into feet - have referred to Physio.

  11. RobinP

    RobinP Well-Known Member

    Thanks for the update Issy1

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