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Mountaineering-induced bilateral plantar paresthesia

Journal: The Journal of the American Osteopathic Association Date: 2014/07, 114(7):Pages: 549-55. doi: Subito , type of study: case report

Free full text   (https://www.degruyter.com/document/doi/10.7556/jaoa.2014.108/html?lang=de)

Keywords:

foot diseases [2]
male [479]
osteopathic manipulative treatment [2973]
OMT [2951]
paresthesia [3]
case report [514]

Abstract:

CONTEXT: Flat feet (pes planus) have been implicated in multiple musculoskeletal complaints, which are often exacerbated by lack of appropriate arch support or intense exercise. OBJECTIVE: To investigate the efficacy of osteopathic manipulative treatment (OMT) on a patient (K.K.H.) with mountaineering-induced bilateral plantar paresthesia and to assess the association of pes planus with paresthesia in members of the mountaineering expedition party that accompanied the patient. METHODS: A patient history and physical examination of the musculoskeletal system were performed. The hindfoot, midfoot, forefoot, big toe, and distal toes were evaluated for neurologic function, specifically pin, vibration, 10-g weight sensitivity, and 2-point discrimination during the 4-month treatment period. To determine if OMT could augment recovery, the patient volunteered to use the contralateral leg as a control, with no OMT performed on the sacrum or lower back. To determine if pes planus was associated with mountaineering-induced paresthesia, a sit-to-stand navicular drop test was performed on members of the expedition party. RESULTS: Osteopathic manipulative treatment improved fibular head motion and muscular flexibility and released fascial restrictions of the soleus, hamstring, popliteus, and gastrocnemius. The patient's perception of stiffness, pain, and overall well-being improved with OMT. However, OMT did not shorten the duration of paresthesia. Of the 9 expedition members, 2 experienced paresthesia. Average navicular drop on standing was 5.1 mm for participants with no paresthesia vs 8.9 mm for participants with paresthesia (t test, P<.01; Mann-Whitney rank sum test, P=.06). CONCLUSION: These preliminary findings suggest that weakened arches may contribute to mountaineering-induced plantar paresthesia. Early diagnosis of pes planus and treatment with orthotics (which may prevent neuropathies)--or, less ideally, OMT after extreme exercise--should be sought to relieve tension and discomfort.


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