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Friday, March 7, 2014

Friday's Patient Problem of the Week: Measuring Range of Motion 2nd Metatarsal Phalangeal Joint

A patient presented post operative 2nd metatarsal phalangeal joint. The joint was very stiff and painful and she wanted advice on increasing the range of motion and minimizing the pain. As she walked, she felt that the bottom of the base of the toe would stay against the ground and cause pain. She felt that the toe would not move up as she walked through her foot. Even though the pain was on the bottom of the toe at the MPJ, she felt that the restriction to bending the joint was in the top of the joint. 

2nd MPJ with healed surgical scars, but too much restriction at the top of the joint. Patient started on joint mobilization (like with Hallux Limitus) and cross frictional massage with a Blaine Scar Treatment Kit.

Tin Foil is used to give the patient a reference point before and then after treatment. With the toe bent upwards as much as possible, the tin foil is massaged into the skin to represent that area. About a 6 inch strip of tin foil is used and folded on itself to get some rigidity. 

Once the tin foil is removed for the skin, the patient can observe the angular relationship to the toe to the metatarsal (here before mob and massage). I can measure this as a 19 degree angle. 

After mobilization and massage, the angular relationship is remeasured and the patient can see how their treatment is working. Doing this multiple times a day (2-3) for several months (3-6) can give a consistent improvement. Remember no pain in this treatment. Here I measured the same patient at 40 degrees post mobilization and gentle cross frictional massage of 2 minutes. 

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