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Burning feet
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Burning feet - April 25, 2006 3:56:00 PM
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ginger
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Joined: February 26, 2005
From: Melbourne Victoria
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Interesting case currently attending for treatment.
A 48 year old male office worker , largely sedentary, overweight, 185 cms tall 92 kgs.Unfit, not inclined to exercise at all.
Complained of intense burning feelings to both feet , extending to mid calf posterolateraly. This had been slowly increasing in intensity and duration over a six month period. Prior to first attending here was also bothering him at night. Also more recent episodes of similar burning sensations to palms L=R and to the bottom lip.
Had been sent to a neurologist by his GP , who performed various nerve conduction tests with mixed results. A conclusion not reached by the neuro , further tests scheduled and a preliminary diagnosis of un-named neuro pathology suggested.
patient in a state of distress , mostly about the prospect of disabling disease.
Not bothered by pain , mentioned a stiff back "for years". Was not inclined to walk far or stretch as he feared this may exacerbate the symptoms.
Observations of his vertebral spine and state of extensibility included, at first assessment,
Unable to reach toward toes beyond mid calf with legs straight in standing.
Guarding behaviours noted with most movements, antalgic gait pattern with delicate foot falls.
Stiff ++ lumbar vertebral spine assessed with active and passive movements.
Treatments have been thus far 5 sessions of mobilisations to individual facet joints and stretches, including ballistic stretches to lumbopelvic dura.
Results began to appear after two treatments, with decreased burning sensations to feet, with this decrease noted after each treatment session so far. Now walking without antalgic gait , improved flexibility and confidence with most movements.
Began mobs to C spine at session three, with similar reductions to palm and lip burning.
Recent assessment showed he now complained of short periods of burning to feet , though to a greatly reduced degree and area, confined mainly to soles of both feet.
I anticipate further improvemnts as his range of facet joint mobility improves along with dural length.
All mobs performed in prone according to the continuous method, although AP mobs are planned for the C spine as time and progress alllows.
No reassessments done by Neruologist as yet , one scheduled for late April.
Keep you posted.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Burning feet - April 26, 2006 2:10:00 PM
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nari
Posts: 1568
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From: Australia
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Hello Grand Pediculator
Have you ever done your spinal mobs technique on folk with signs of peripheral neuropathy? I know it is considered central in origin, but nothing is certain these days...
Nari
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Re: Burning feet - April 26, 2006 2:51:00 PM
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ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
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HI Nari , well I guess this was thought to have been a person with peripheral neuropathy, so yes. I treat the signs as i see them, that is , while presenting with what may have been peripheral neuro pathology, I noted distinct stiffness and tightness so proceeded with that. What he and I looked and hoped for of course, was that his burning symptoms would turn out to be the ordinary business of referred altered sensations related to facet hypomobility and inflammatory events. And so it appears to be.
As you would expect he is very pleased with results so far. Not sure if it is worth my time to go into detail explaining all this to the neurologist however.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Burning feet - April 26, 2006 3:46:00 PM
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nari
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He isn't very likely to believe you, anyway.
It's always useful to treat a process regardless of a compartmentalised series of diagnoses.
Nari
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Re: Burning feet - April 26, 2006 5:29:00 PM
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ginger
Posts: 660
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From: Melbourne Victoria
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It would be too easy to get caught up in a totally sceptical view about Nerologists in general, I'm fond , like you Nari , of making my own assessment and following my own star. No doubt many of our North American colleagues would wish the same could be done there. Bring on independant PT diagnosis and treatments , the sooner the better.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Burning feet - April 27, 2006 11:14:00 AM
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JLS_PT_OCS
Posts: 1684
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From: USA
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(I know this is a foolish question, but I'm an eternal optimist)
Why don't you publish this as a case report and bring your treatment methods and this patient's case to the world?
It might open up whole new avenues of treatment for many patients...
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Burning feet - April 27, 2006 11:45:00 AM
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nari
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From: Australia
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Ginger
As Jason's signature suggests:
>>It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express.<<
You should publish; have a nosey around and see what publication would be likely to accept case reports.
I agree that total freedom to treat and manage a practice exactly how one chooses is a very valuable asset. But we have had that ability for so long, it is hard to conceive any other way.
Nari
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Re: Burning feet - April 27, 2006 1:48:00 PM
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ginger
Posts: 660
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From: Melbourne Victoria
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Jason , I don't see any of your questions as foolish , yes it would be a fine thing to bring about the altered perceptions and ultimately results , you mention. As I've repeated here however , I just don't have the resources at this time. I am committed in my own way to offer my methods and experiences to as wide an audience as possible. For now , that audience includes you and others in this forum. I have been a little busy in another arena, a local University is taking an interest in a lecturing proposal I've submitted. Should I take a post at this teaching institution, I've asked that access to research facilities and students be offered as part of the deal. I'm hopeful and encouraged by their enthusiasm thus far. I see this as the next logical step in my vision of transforming the world of musculoskeletal physiotherapy.
Keep you posted and I have no intention of drawing any curtains over my work or methods, they are there for all to see hear and learn as able.
Just a simple country boy trying to make a difference.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Burning feet - April 27, 2006 5:13:00 PM
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JLS_PT_OCS
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From: USA
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Doesn't take any significant investment of time or resources to write a case report...
:)
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Burning feet - May 4, 2006 2:33:00 PM
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ginger
Posts: 660
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From: Melbourne Victoria
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Saw this guy again yesterday, He complained about his feet burning , after a 50 minute power walk!, which went away after a session of L5S1 mobs and dural stretches ( yes, ballistic Nari ). Seems now he only gets symptoms under the effect of increasingly longer walks . This is a guy who never exercised before.
I do suspect that there is a certain amount of neural/spondylar encroachment of bony substance at various levels . Nothing I can deal with there , but still exploring , to so far good effect , the value of restoring normal movements.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Burning feet - May 4, 2006 3:55:00 PM
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Shill
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From: Madison WI USA
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Ginger,
I ask this with all sincerity. What if you just lie him down for the same duration it takes you to do the facet mobilization and dural stretches. Does he get the same improvement? Just unload him by having him lie down. Not in the clinic , that would be a waste of your time, just at home some time for the same duration. What happens to the feet then?
Steve
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Steve Hill PT
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Re: Burning feet - May 4, 2006 6:53:00 PM
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ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
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Good question Steve, He reported at first assessment that the burning kept him awake, and had progressively increased over six months , till coming to me . Since then the periods of burning , including times at night , and with rest, are considerably less. When he lies down now , after a walk , it may yake up to an hour and a half for the burning to besomewhat relieved, with further improvements now noted overnight.
With mobs however , this takes about ten minutes to be relieved.
There is certainly a result, relief, with unloading , as you say . Though it appears a significant improvement had not been the case with just rest previous to my attentions.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Burning feet - May 5, 2006 5:47:00 AM
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dfjpt
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>48 year old male office worker , largely sedentary, overweight, 185 cms tall 92 kgs.Unfit, not inclined to exercise at all.
I presume possible diabetic neuropathy was ruled out in this individual?
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Re: Burning feet - May 5, 2006 2:28:00 PM
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ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
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No diabetes dfjpt, and no weakness, palsy, or confirmed neuropathology. Sciatic nerve conduction tests were equivocal.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Burning feet - May 9, 2006 6:53:00 AM
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Shill
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From: Madison WI USA
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Thanks Ginger, just curious. Glad you consider those things (unloading) that are part of what you do. Ten minutes for symptom relief is better than 90. I can do that math.
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Steve Hill PT
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Re: Burning feet - May 9, 2006 11:37:00 AM
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sinistre
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From: Norway
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I've seen this fixed using Active Release Techniques to the tarsal tunnel. If you don't know ART you may try to mobilise the tissues surrounding the nerve as it passes through the tarsal tunnel.
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Ole Johansen, PT, OMT, ART
http://www.muskuloskeletal.no/
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Re: Burning feet - May 10, 2006 2:07:00 PM
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ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
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Further update on this fellows burning feet. It is interesting that this is his only symptom. Quite unusual for someone who responds well to what appears ever more to be a joint/nerve problem. At least that is the seemingly correct conclusion now he has progressed still further. Now walks weel without apparent limp. Balance reactions improved in standing ( tested with one leg stand, eyes closed , now at 40 seconds/55 secs L/R, previously , day one , 4 secs/8 secs.)
Improvements noted to Lumbar mobility and patterns of paralumbar recruitment .( tested by holding an extended posture in prone now able to hold indefinitely , earlier unable to hold longer than 15 secs )
Will get a transcript of his neurologists report if I can and post it.
Cheers
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Burning feet - May 11, 2006 1:50:00 PM
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nari
Posts: 1568
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From: Australia
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ginger
You neuromodulated him - moving the joint may or may not have had anything directly to do with it, but simply a means of access to the CNS and its origins.
Nari
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Re: Burning feet - May 16, 2006 4:57:00 PM
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ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
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yeah right.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Burning feet - May 16, 2006 10:05:00 PM
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nari
Posts: 1568
Joined: November 14, 2003
From: Australia
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To each his/her own, ginger, as long as it fits with physiology.
Nari
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