Bruce,
You mentioned :
"Could treatment of plantar digital neuritis involve local neural
mobilisation?  I'll try it and see what the response is."

I did experience that effect only on handful of patients. There was a
definite reduction in pain levels on nerves that were under stress once the
associated nerves were stretched. I do prescribe necessary neural stretching
and mobilisation exercises to most of my patients with digital plantar nerve
issues, or any other stress related nerve trauma. It seems to work. How
effective? - I am not sure. On the other hand, one can not deny the
mechanical factors associated with digital neuritis, neuroma, or
neurofibroma.



On the issue of driving - It is interesting to see the resemblance of
sitting position (during driving) to 'slump test'. In both cases there is
hip flexion, slight leg raise with some ankle dorsiflexion. It is possible
to induce pain at various levels of nerve paths where there is sagittal
movement of body parts. This could be at the level of neck, lower back,
behind the knees and plantar heel and planta metatarsal areas. When they all
flex simultaneously, the lengthening effect seem to induce pain. It would be
an interesting area to do some research.  When I mention this to some of my
lecturers and peers, the answer is unanimous: "Nerves are bad news, man -
Don't even get there."





----- Original Message -----

From: "Chapman Clive" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, March 14, 2003 7:45 PM
Subject: Even more about neuromas


> After my posting last night I had a patient present with bilateral
forefoot
> pain which proved to be caused by  - in my opinion -  neuromas, Mulder's
> clicks etc. This man has a long history of back pain, lower mid and upper,
> but has been free of the back pain for the past 6 months.
>
> Given my findings on the patient that I saw before, I did neurodynamic
tests
> and was able to reproduce the neuroma pain with SLR+eversion+toe
extension.
> So, the suggestion that "the nervous system never forgets an injury" may
be
> true and it  waits only to be aroused by a further instance of neural
> stress.  I have to confess I am now biased in looking at this as part of
the
> aetiology, but it is an exciting possibility.
>
> Could treatment of plantar digital neuritis involve local neural
> mobilisation?  I'll try it and see what the response is.
>
> Are there any physical therapists out there who could throw light on this?
>
> Clive
>
> Clive Chapman, Head of Foot Health Services
> Haringey Teaching Primary Care NHS Trust
> Telephone 020 8442 6438
>
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