Members do not see these Ads. Sign Up.

Moring All,

I have a 26 year old female patient who is presetig with forefoot numbness in both feet on the plantar surface and the apices of digits 2-5 bilaterally.
She has a positive tinnels sign on left leg only,
pain on palpation of post tib, soleus muscle belly on left foot only
peroneals firing contantly experioecing spastic paralysis
-ve for mortons nuroma, stress fracture
unable to have the bedcloths on toes as they are too sesitive, pt has to sleep on stomach
and yes she wore heels out a feww times and each time she did the numbness appeared and also when she runs she sometimes reprodiuces the symptoms. ( I looked at her runing gait, runners varus noted

I have ben treating her for a few weeks with a combination of dry needleing to peroneals, TP, Gastrocs, with stretchig , and soft tissue therapy, and modified her orthoses with met domes, incressig the rearfoot post, all of which stopped the numbness, though the peroneals are still 'hard',


My thoughts, tarsal tunnel syndrome? s2 nerve root compression? plantar nerve entrapment?( also palpable pain uder abductor hallucis muscle belly)

today I have strapped her with a combination high dye, low dye soft tissue work to her legs which gave her some relief. I inverted her rearfoot posts on her orthoses by a further 2 degrees (approx) inv.

could I get some suggestions ? am I o the right track?

kind regards
Bren

 

Something you may not have tried is supporting the forefoot with a met pad/dome between the 3rd and 4th toes and offering a 2-5 extension in cork. Provide a first out in the shell to plantar flex the first. The peroneals might be fighting the inversion of the orthotic. I would maybe entertain more mid foot support/medial flange in orthotic style.