The History of Manipulation (A very brief guide!)

Joint manipulation is a very old form of treatment that has been utilised by many medical professions over the years, in Podiatry however it is only now becoming popular. Joints within the foot can be manipulated; simple gentle manipulation can produce some very powerful results where traditional treatment modalities have failed.

Manipulation has been used for centuries and is still not fully understood, but it is very effective. There are several modern day styles of manipulation being used today these where developed by Still (1890’s Osteopathy), and Coleridge (1900’s Chiropractors). Many different practitioners utilise manipulation i.e. Physiotherapists, Orthopaedic surgeons, dentists and now Podiatrists. There have been many complex neurological and physiological explanations as to how joint manipulations work but none satisfactorily explain why or how they work or how they alleviate a patient’s pain.

Various forms of manipulations exists some work on soft tissue others work directly on joints. Examples of these techniques are high velocity techniques, low velocity techniques, soft tissue trigger point release work, a wide selection of other techniques exist. The usage of manipulation technique is dependent upon the professional utilising it.

Podiatrists utilise manipulation to help mobilise patients feet and help cure foot pathology. This can be a very useful when several other treatment modalities have failed to help these can include X-rays, Corticosteroids, insoles, stretching exercises, and in extreme cases surgery. Manipulation can be used to prevent surgery and the need to prescribe drugs or expensive custom made functional foot orthotics. The results of manipulations are varied a single manipulation can cure months of pain whilst several manipulations may be needed for more complex problems. On the reverse side of the coin manipulation may not yield any positive effects to help pain and discomfort. A practitioner will need to assess a presenting complaint before an effective manipulation treatment plan can be formulated. Manipulation can be used in conjunction with several other treatment modalities to achieve the best results.

Why Use Foot Manipulation?

• Alternative to surgery, cortisone injections, and anti-inflammatory drugs.
• Suitable for patients unwilling to undergo surgery, or take medication
• Increase the range of motion within a joint
• It is very cost effective for the medical practitioner, this helps to save on resources
• Useful for patients unsuitable for surgery / drug intervention.
• Rehabilitation of sports injuries and surgery

What Foot Conditions Will Respond to Manipulation?

This is not an exhaustive list but major conditions include: -

• Alternative to surgical procedures (neuroma excision, athrodesis).
• Improve range of motion is “stiff” joints
• Nerve entrapment conditions i.e. Deep Peroneal, Sural, Tibial neves, etc. All these nerves have been demonstrated to cause some for entrapment and symptoms.
• Release muscle spasm, improve muscle function and strength
• Foot surgery and sports injuries.

When is Foot Manipulation Not Useful?

• Severe Osteoporosis - high velocity techniques could fracture bones.
• The possibility of a diagnosis of a fracture in an area to be manipulated.
• Unstable joints where ligaments / tendons tear could occur.
• Any health complaint where the muscular system could be impaired.
• Basically and bone pathology or inflammatory state around a joint

Conclusion

Foot manipulation when administered in a safe way (GOOD PATIENT SCREENING) is an extremely cheap and effective treatment. Podiatrist administer foot manipulations to help various problems within the foot.  Our clinics have been manipulating feet for several years now and we have seen a large number of patients which have benefited from this technique of treatment.

If you would like to book an appointment for manipulation or like more information then please do not hesitate to contact us.

References

• Cashley, D. Case Report - Manipulative Therapy in The Treatment of Plantar Digital Neuritis (Mortons Metatarsalgia), British Journal of Podiatry 3(3)pp67-70
• Roger Kingston, Foot Manipulation, PBG Meeting Leeds 2000
• Tollafield, David.R.,Merriman, L – Clinical Skills in Treating The Foot (Churchill-Livingstone)p3-4