Manual Therapy for Morton's Neuroma

[Laura Thornton]

I came across an article this week describing a case report using a lot of the techniques we learned this past weekend for a patient with Morton’s Neuroma. Side note, it’s co-authored by Dhinu Jayaseelan, who was the guest lecturer for the VOMPTI course series during Weekend 2!

Interesting points in the article:
– Bilateral pes planus and forefoot varus with drooping of 4th and 5th metatarsal heads visible in non-weightbearing.
– Reproduced pain with dorsal glides of 4th metatarsal on cuboid
– Primary impairment identified for treatment was midfoot hypomobility causing greater stress across lateral forefoot during stance and push-off
– Included cuboid whip manipulations with reassessment of toe walking –> I assume to improve her ability to wear high heels

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[omikutin]

This is really funny, thank you for sharing! I read this case report earlier this week. I have a patient currently with morton’s neuroma and I found this article as well. I wonder how this article taught the self navicular glide? For my patient, something that I found helpful was reviewing his footwear. He said he felt better walking barefoot as compared to sneakers. Overall, walking was more difficult. I reviewed another article that mentioned “chronic trauma occurs to the forefoot and plantar intermetatarsal structures, including the communicating branch in the third webspace. This may be aggravated during ambulation in which dorsiflexion of the toes and contraction of the flexor digitorum brevis stretches the common digital nerve, causing a traction injury”. Maybe that’s why mobilizing the mid foot is vital. As well, I showed him shoes with a wider toe box could help decreased the tension on his mid-foot. We’ll see how that goes this week.

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