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National Board Apologizes for Testing Issues
The National Board of Chiropractic Examiners (NBCE) has issued a formal apology following a series of computer-based testing malfunctions that impacted two separate examinations (March and June 2016) and caused "widespread confusion and frustration" to the nearly 1,500 examinees taking the tests.
Integrative Cancer Care: Chiropractic for Chemotherapy-Induced Hiccups
Hiccups (singultus) are a frequent occurrence during cancer treatment. The cause of the hiccups may be the chemotherapy drug itself, such as Cisplatin; or the prophylactic use of corticosteroids such as Decadron, which is used to prevent nausea and/or vomiting.
Pediatric Asthma: A Case Study
I have had very good success with pediatric asthma, combining acupuncture with Chinese herbal products. Treatment is given over four to eight months, twice monthly, with herbal formulas rotated every month.
Getting Paid by Medicare Is Getting a Major Adjustment
The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law to implement a new approach to clinician payments and replace the Sustainable Growth Rate formula.
Natural Cancer Prevention: Pomegranate for the Prostate
In recent years, the ingestion of pure pomegranate juice (8 ounces per day) has been shown in clinical studies with human subjects to slow, and to some degree, reverse, the progression of prostate cancer – the second leading cause of cancer death in North American men.
U.S. Olympians Have a DC in Their Corner
It's probably old news to you that doctors of chiropractic play an increasingly prominent role in treating athletes, from youth sports participants to weekend warriors, to elite / professional competitors.
Six Things Every DC Should Know About the Zika Virus
The Zika outbreak continues to spread across the continental United States and U.S. territories. We offer this brief overview on this important public health problem for the practicing doctor of chiropractic.
Dysautonomia: The Medical Condition You May Already Be Treating
TCM practitioners have spent thousands of years healing patients without knowing or needing the names of their diseases as defined by allopathic medicine. We have syndrome names that are both poetic and efficient.
Decoding the Mystery of Medical Insurance Acceptance
In the constantly evolving profession of acupuncture, one of the least understood areas is medical insurance acceptance. The profession is filled with controversy surrounding this topic: Is it ethical?
Workers' Back Pain: Causes, Costs & Solution
You will want to share two important papers published in the past several months. Why? When read separately, each provides valuable information relevant to your patients, community and practice; together, they tell a compelling story.
Four Ways to Attract Patients
Acupuncturist A has been in practice for six years and has struggled since day one. She spends as much time and money on marketing as she can, but since her practice is slow, her budget isn't that big.
Upgrade to "Parker 2.0" in Las Vegas
Continuing your education and refining your practice: two key elements of a successful chiropractic career. Parker Seminars promises both as it celebrates its 65th anniversary in Las Vegas next February, according to Parker University President, Dr. William Morgan, and seminar consultant Dr. Mark Sanna.
ITB Syndrome: Treat the Tensor Fascia Latae
Iliotibial band syndrome is usually the result of repetitive knee flexion, such as in runners or cyclists. Pain may be experienced in the knee and/or the hip. The patient may express a sense of the hip dislocating, popping or snapping.
Using the Lens of Chinese Medicine
One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine.
First Annual ICD-10 Updates Take Effect
Yes, there was an update to ICD-10 codes on Oct. 1. It was a regular update to the diagnosis coding system and will take place every Oct. 1, just as it did when the ICD-9 system was in place.
Update from the International AIDS Conference
The 21st International AIDS Conference in Durban, South Africa, brought together more than 15,000 of the world's leading scientists, activists, funders, policy makers, and consumers from 153 countries.
Treatment Success at the Won Institute
According to the World Health Organization's 2003 report titled, "Acupuncture: Review and Analysis of Controlled Clinical Trials," acupuncture has been shown to improve many physical, emotional, and mental conditions.
Treating Peripheral Neuropathy: Multi-Faceted Approach Including Laser Therapy
Peripheral neuropathy affects at least 20 million people in the United States1 and nearly 60 percent of all people with diabetes suffer from diabetic neuropathy. Many suffer from the disorder without ever identifying the cause.
Going Beyond Just Feeling Good
We all know that most patients come to us for some pain complaint: neck pain, back pain, sciatica, carpal tunnel, etc. We also all know that acupuncture is a great first-line care for these issues, as well as supporting overall health and wellness.
Pediatric Footwear: Function Over Fashion
As practitioners, it is not uncommon for parents to bring us their children to treat or ask us questions related to the pediatric population. Children's feet tend to be a perplexing region for parents and practitioners alike.
Power to the Patient
Against a backdrop of splintered political parties, polarizations within nations, civil unrest, and distrust of established government (such as the growing anti-Washington, D.C. sentiment) comes the not-so-surprising finding that health care authorities and practitioners (with perhaps the exception of insurers) are turning over more and more powers to the individual patient.
Prevention vs. Intervention
Why intervention can be the quality of life choice.
Pain is one way we learn. Most recently, the pain of my wife's fractured big toe led us to seek out a foot doctor. During conversation with him, I learned that the progression of immobility within the first MTP (metatarsophalangeal joint) can be a significant contributor leading toward an eventual knee replacement.1 This was a new awareness. As my newest course that I am now teaching is the Aspiration to Prevent Hip, Knee, and Shoulder Replacements, his clinical statement intrigued me. Also, one of the themes of this column continues to be: Our profession has the ability and skills to function as an early detection team for our clients; so I requested Dr. Bradley J. Makimaa DPM, FACFAS, to guide my understanding in preparing this article.2
Sadly, many of our clients live with chronic foot pain when an ounce of prevention could make a huge difference in their comfort level with skilled attention and care by a good foot and ankle specialist. And at other times, our clients present to us with problems that require a true pound of cure but don't know what their options are or from whom to seek qualified help. Clients do listen to our encouragements to seek proper medical care when we have an informed opinion. That's the purpose of this article, to contribute to you developing an informed opinion.
For many of our clients, stiffness and pain in their feet progressively emerges as they walk, dance, or run over the years. The foot joint being highlighted in this article is the condyloid synovial joint at the base of the big toe, the metatarsophalangeal joint. The early stages of this progressive degeneration is known as halux limitus. As the problem progresses toward joint immobility, it's latter stages are diagnosed as halux rigidus. This progression toward immobility is considered to be a form of degenerative arthritis.1 A history of having fractured or having severely "stubbed" the same big toe is a common human experience and is a question to ask of our clients.
As bodyworkers and massage therapists, we can easily feel the stiffness and the calcium deposits around this joint when it is progressing toward degeneration. A simple distraction and mobilization technique that I use is to traction the joint to the first barrier to motion, lifting the toe slightly, then request the client to push their big toe downward. Most often, the joint will slide and the active plantar flexion movement will reduce its compression. If, on the other hand, this produces quite a bit of discomfort or pain, and has a very limited range of motion, then the client is probably into the halux limitus territory and needs to be referred to a foot and ankle specialist. This is the ounce of prevention indicator.
In contrast, all of us have experienced clients presenting with a big toe that doesn't move at all. Sometimes it will be swollen and painful and sometimes it will be so stiff that palpation doesn't hurt in the least. Sadly, this means that the joint is frozen and that halux rigiditus is probably the more appropriate assessment. Occasionally, these symptoms will indicate a chronic gout condition. Again, an encouraging referral is in order. This is the pound of cure territory.
Let's now consider Dr. Makima's clinical experience on how this eventually contributes to knee deterioration, interventional surgeries, and possibly even knee replacement. "When patients have this ongoing limitation at the base of their big toe, their foot must invert to continue through the push-off phase of gait. It is the easiest compensation and closest in proximity to the motion. It really comes down to gait and having watched thousands of patients with this condition. They all invert their foot, i.e., tilt the sole of the foot toward the midline, to continue the push off phase of gait and continue the natural motion they used to have, only now all joint dorsiflexion and plantarflexion is done with the MTP's of the 2nd through 5th toes. This late phase inversion causes a closed chain external rotation of the leg and the knee and thus an exaggerated overloaded varus position of the knee at toe off."2
Varus, means bow-legged which adds compression and directs the force of each heel strike moving through primarily the medial compartment of the knee instead of being distributed between the medial, center, and lateral compartments of the knee.3 "Further, this results in a wiggle-waggle hip motion attempting to bring the foot back to a neutral position during the acceleration phase. Many of the patients I have seen with this gait have had one or several knee surgeries. Some led to knee replacements. I always ask if they have ever had the big toe addressed by the orthopedic surgeon or foot and ankle specialist (as they had an obvious giant bone spur formation and reported pain). The answer almost unanimously is "we will deal with the knee first" or, "no it has never been addressed."
I have had several patients cancel knee surgery after having a first MTP implant. I can't speak as to the long-term knee follow-up and previous damage but the correct gait with appropriate rehabilitation follow-up after surgery, definitely removed their knee pain."2
Having an implant done for the first MTP is the pound of cure approach that many of our clients may need, as it will allow them to continue a more active lifestyle and thus maintain their quality of life. Our collective desire as a profession to prevent physical deterioration can only assist those whose degradation hasn't spiraled downward to the point where medical intervention does need to be considered. Being alert to the conditions and symptoms which may indicate that such interventions are a possible necessity is a very significant service to our clients.
Dr. Makima states that overpronation, eversion during the push off phase, is the root of most foot pain and dysfunction and that orthotic support will always be helpful if that is part of the underlying cause. Taping procedures can be helpful to those whose big toe limitations and pain have not progressed beyond such conservative measures.
Additional red flags for when to refer clients to a foot and ankle specialist include:
The many additional foot and ankle problems that our clients may experience are beyond the scope of this article. However, the next time someone's big toe doesn't move with ease or is painful to palpation, do encourage them to see a foot and ankle specialist, their physician, or an orthopedist. Be a part of your clients' early detection team.