Louw - Where are your feet

IPTA Feet - Colleen
Fall 2013
1. Discuss different kinds of pain
2. Discuss traditional “bottom-up approach”
Colleen Louw, MPT, MEd, CSMT
3. Discuss rationale for a “top-down approach”
4. Testing a sensitive nervous system
5. Treating a sensitive nervous system
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Pain or Brain
Problem
 Nociceptive:
Joint or Tissue
Problem
 PT
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Issues in the Tissues
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IPTA Feet - Colleen
Fall 2013
Hypersensitive
Nervous System
T I M E
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 Change
how the brain
sees/senses tissues
 Changes
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pain
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IPTA Feet - Colleen
Fall 2013
“Don’t walk barefoot
ever again!”
LARGE
SMALL
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Smudges and blurs
Left or Right?
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IPTA Feet - Colleen
Fall 2013
Smaller
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 Two
Point Discrimination
 Graphesthesia
 Proprioception
 Light
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Touch
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IPTA Feet - Colleen
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Fall 2013
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IPTA Feet - Colleen
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Fall 2013
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IPTA Feet - Colleen
Fall 2013
As long as pain and sensitivity is so high, the
extremity does not want to be touched, moved or
used
As long as the brain does not understand
the pain and does not even know what left
and right is, there is no incentive to reduce
it’s most potent protector:
PAIN
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No issues in the tissues
Tissues heal
Explain brain maps
Use it or lose it
•
Brain Exercises:
• Left/Right
• Your foot
• Normal foot
• Restoring the map
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IPTA Feet - Colleen
Fall 2013
 Why
discrimination and not integration?
It HAS TO BE deliberate!
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 Patient
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Example – Hypersensitive feet
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IPTA Feet - Colleen
Fall 2013
 Patient
 CRPS
Example
Face
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 If
you know your
neighbors, you can
find your house
 Example:
• Toes 1-5, but 3 is too
sensitive
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IPTA Feet - Colleen
•
Fall 2013
Beans
• Introduce (visual) the sensation of
beans
• Deliberate
• Close eyes – form a memory
•
Add other objects
• Teach what they should feel like
• Into the beans…go hunt!
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IPTA Feet - Colleen
Fall 2013
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
63 year old male

 Started 2 years ago – progressively worse

 Dx: Transverse myelitis
 Inflammation of spinal cord
 Short term relief with acupuncture, but pain has returned
Examination:
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 Difficulty moving feet; shuffle gait; walks on his heels; ++
fatigue
+++ tender to palpation of his feet
Functional LE scale: 63%
ROM WFL bilateral feet
Strength B LE 4+/5
 +++ Fatigue
 Increased numbness in his feet
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Medical
 HTN; Heart disorder; High cholesterol
 Bilateral weakness and bilateral hypersensitive feet
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IPTA Feet - Colleen

Fall 2013
Special Tests
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Session 1: 6/13
 Evaluation
 Two Point
TPD: Unable to feel any TPD > 10 cm
R plantar: Absent sensation
L plantar: Absent sensation
R dorsum: Intact sensation
L dorsum: Absence around digit 1 & 2
Balance:
Discrimination
 Heel raises
 Wall leans
 One-legged
stands
 R foot 4 seconds
 L foot 10 seconds
 HEP
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Session 2: 6/16 (3 days after initial)
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 TPD = 8cm L = R
 Treatment:
 Two Point Discrimination
 Heel raises
 One-legged knee bands
 Monster walks
 Side stepping
 Wall leans
 One-legged stands
 HEP
Session 3: 6/21 (8 days after initial)
TPD = 5cm L = R
 Treatment:
 Two Point Discrimination
 Heel raises
 One-legged knee bands
 Monster walks
 Side stepping
 Wall leans
 One-legged stands
 HEP
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IPTA Feet - Colleen
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Fall 2013
Session 4: 6/23 (10 days after initial)
TPD = 4cm L = R
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 Treatment:
 Two Point Discrimination
 Heel raises
 One-legged knee bands
 Monster walks
 Side stepping
 Wall leans
 One-legged stands
 HEP
Session 5: 6/28 (15 days after initial)
TPD = 4cm L = R
 Treatment:
 Two Point Discrimination
 Heel raises
 One-legged knee bands
 Monster walks
 Side stepping
 Wall leans
 One-legged stands
 HEP
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Session 6: 7/5 (22 days after initial)
TPD = 4cm L = R
Still decreased TPD on balls of the feet R > L
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Session 7: 7/13 (30 days after initial)
TPD = 2cm L = R
 Treatment:
 Two Point Discrimination
 Heel raises
 One-legged knee bands
 Monster walks
 Side stepping
 Wall leans
 One-legged stands
 HEP
 Treatment:
 Two Point Discrimination
 Heel raises
 One-legged knee bands
 Monster walks
 Side stepping
 Wall leans
 One-legged stands
 HEP
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IPTA Feet - Colleen
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
Fall 2013
Session 8: 7/26 (43 days after initial)
TPD = 2cm L = R
 Doing well
 Strength 5/5
 TPD WNL
 Light touch restored
 All goals achieved: functional scale 96%
 DC PT
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