Thursday, April 19, 2007

Case Study: Pain in the Metatarsophalangeal Joint

A friend mentioned today that for the last 2 weeks she has been experiencing pain on the inside of one of her feet behind her big toe when her toes are bent forward and bearing weight.

The friend is between 25 and 30, female, and fit. She is moving to a new town, in with a new roommate and new job. She is newly single. She has been doing yoga for 10 years.

She showed me all the moves that cause it the most distress. The action of rolling forward into Cobra or Updog and back to Down Dog and the action of pivoting from sole of the foot on the ground onto the ball of the foot were the primary ones.

1. First Step
I pulled out "Trail Guide to the Body" and looked up the spot. I learned that between the 2nd and 3rd bone of the Big toe side of the foot is called the Metatarsophalangeal Joints. The spot is also known as the "Base of the Phalanges". The Tendon that attaches the Base of the Phalanges to the Metatarsals is called the Abductor Hallucis.

2. A Guess
My guess was that she should stop doing what hurts it and follow the R.I.C.E. protocol. "Rest, Ice, Compress and Elevate." Yet she should continue to move it in gentle circles and keep blood and attention flowing to it.

3. Google
Since my pal thought she had a sprain I typed in "abductor hallucis" with 'injury' and 'sprain' into GOOGLE. These searches revealed that an injury in this spot is super common among football players and is often called "Turf Toe". I also learned that it is the joint that bunyans often grow from and a hot spot for arthritis.

4. Nerve Pathways
One site mentioned the nerve connection to the Sacrum, which inspired me to pick up the Atlas of Human Anatomy by Netter. From this I was able to see the nerve relationship between the S1L5 and that spot in the foot.

5. Conclusion
I was not able to discover any "magical cure" but the increase in the understanding of a 'problem' will often open you up to new insight. And in our research, we began a dialogue that led us up through her whole spine into a much more integrated discussion about how she was put together.

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