Some osteopaths neglect foot technique in patient care as they find the techniques difficult to master, and sometimes uncomfortable on the hands. Many cases of foot dysfunction receive benefit from general mobilization and some practitioners are happy to use such methods rather than specific techniques. However, specific techniques can often be a short cut to good results, and save not only time and effort, but can produce a better and longer-lasting relief from mechanical dysfunction problems. The foot is the foundation of posture, and to neglect it is to leave out a very important part of patient care. Clearly a poor foundation is not going to help in resolution of mechanics in other parts of the body if a practitioner is trying to restore good function. There are also local problems of pain and disturbed mechanics in the foot that can often be suitably addressed by osteo-pathic treatment.
As in all areas of the body, particular care must be taken in cases of potential bone weakness as techniques may induce quite strong effects on bone. However, the chance of damage is quite small, as the stresses used are liable to be less than those in normal locomotion. Infection, cellulitis and inflammatory disorders are common in the foot, and will need careful pre-treatment assessment. By its very nature osteopathic treatment is designed to increase mobility. Many cases of disturbed foot mechanics are due to excess mobility or hypermobility and, therefore, further mobilization may be unwise. In some cases, relative hypomobility in one part of the foot will cause relative hypermobility in another. This is where very specific treatment to the hypomobile section will help to 'unload' the excessively mobile articulations. Hypomobility also seems to have reflex effects in maintenance of hypermobility in adjacent areas. If a hypomobile joint is satisfactorily mobilized, there is often an immediate restoration of ligamentous tone in adjacent, previously diagnosed, hypermobile joints. This is too rapid to be simply a balancing of mechanics, and seems to be due to fascial tension alteration and some proprioceptive feedback mechanism.
Most positions used traditionally for thrust techniques are perfectly suitable for articulation procedures. This is not mentioned each time in the descriptions appended to the photographs to avoid repetition. Where a technique is declared a thrust, a repetitive articulation is usually performed as a preliminary, and if tension accumulates to a suitable sense of barrier, the thrust can be performed. If it does not, repeated articulation may deal with the dysfunction adequately. A suitable thrust barrier has a potential for the short amplitude movement that implies a quite characteristic 'crispness'. Without this the thrust is not liable to succeed as a specific technique and is best avoided, as the tissues may become traumatized. A successful short amplitude thrust performed well is rarely traumatic in the foot. An unsuccessful one may be uncomfortable, although rarely damaging.
33.1 • Kneading of sole supine Stabilize the foot with the cephalic hand and use your thumb to work on the soft tissues of the sole.
Tips: Many patients are ticklish and the grip should be firm but not painful. Kneading is more likely to be of benefit than stretching, as a normal standing posture stretches the tissues more than any technique is able to do. Try varied degrees of plantar flexion to reach different layers of tissue.
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