October 28, 2023 • 25 mins
There are some key considerations that have helped me with foot numbness, tingling, hot/cold sensations.
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(00:01):
Welcome to the Acupuncture Outsider podcast.
My name is Richard Hazel and in the time it takes for you to commute to or from work,
I hope to have shared something of interest about orthopedic acupuncture using motor points,
trigger points,
(00:23):
myofascial slings,
uh neuro functional acupuncture segmental treatments.
Anything that crosses my mind that seems to be of interest.
I hope you'll enjoy it.
Hello and welcome to another episode of The Acupuncture Outsider.
(00:45):
This is Richard Hazel and today I want to talk about some foot neuropathy successes and see if uh see if I can give you some tips that have helped me with some patients.
Um off the bat.
I just wanna say that I am not an expert in treating foot neuropathy,
(01:08):
but when someone has it,
I make an attempt to help them and I've learned some things over um the years of trying to um help those people and I'm specifically thinking about um numbness,
tingling,
(01:29):
cold or burning sensations,
not um I uh maybe another time we'll talk about other things like foot drop and things like that.
I've done some,
I did something about foot drop before and um but I don't wanna talk about the,
the motor nerve,
I wanna talk about sensory nerves.
(01:50):
Um So I've had recently had some successes that came about because of me,
you know,
experimenting a little bit.
Um neuropathy,
foot neuropathy,
um foot numbness is,
or tingling or,
(02:11):
or cold or burning,
they tend to,
people tend to have all of those symptoms at different times.
Um It's as complicated as treating migraines because there are just so many ways to get foot neuropathy.
Uh So you can't,
you can't say I always do this and I or I never do this.
(02:32):
Um You kind of have to know the patient's history and make some um educated guesses about how to best start treating those patients.
And they may have numbness only on the bottom of the feet or they may have numbness on only part of the bottom of their foot or they may have cold um feet,
(02:59):
they may have numbness on the top of the foot.
So,
e everybody's different and that's what makes it hard is because I can't say always do this.
Um What I've learned though,
which I'm wanted to share is regardless of what I'm gonna tell you like what points I use or whatever because there's no set um protocol that I'm aware of,
(03:28):
which is why I've had to sort of study it on my own and try to figure out the best way to treat.
Um I would say always remember that the numbness can be a combination of nerve entrapment and vascular issues.
(03:51):
So,
and I really think do not underestimate the ability of ischemia to cause numbness and the ability of ischemic muscles to entrap nerves.
So,
um,
I,
(04:11):
after a P period of time,
I really had,
had some poor luck,
um,
really bad luck trying to help people with foot numbness or foot burning after chemotherapy.
And I'll just say like,
don't,
you know,
I don't,
I don't treat anybody who's being treated for cancer for because they need to be able to heal for me to help them.
(04:37):
So this is like once they're in remission and they have foot numbness,
I've tried to help people um and have had a lot of failure with it and I recently started to see see better results by treating it as ischemia more than nerve entrapment.
(05:04):
Um If you,
if you're familiar with the Plantar Nerve um podcast where I talk about how the tibial nerve splits and becomes the,
there is a plantar nerve that goes into three branches at the bottom of the foot is sensory nerve.
The plantar nerve is motor and sensory,
but the sensory part is obviously the one that I'm concerned about for numbness.
(05:28):
So there's um there are different branches.
So you're always wanting to consider like what um which branch or branches are,
are most affected.
There's a heel,
there's a medial foot and then there's like a lateral plantar nerve that um affects the bottom of the outer part of the foot and usually toes four and five,
(05:51):
especially five.
So you kind of wanna get a sense of that.
And um I have noticed that when people have numbness on the bottom of their foot,
they very often do have extremely tight plantar flexors like the tibialis posterior,
(06:14):
which can cause that tarsal tunnel issue.
They'll have ischemic toe flexors,
they'll have ischemic ad uh actor um Abductor Hays,
like where that other,
where one of those branches can get entrapped,
they'll have really tight um dorsiflexors like their tib anterior extensor,
(06:37):
digitorum longus,
their perons are tight.
Um People in their sixties and seventies have just ischemic ischemic low leg muscles.
Um And,
you know,
the ones that I'm treating for neuropathy,
it's,
it's extreme.
(06:57):
So,
and I probably talked about that like,
you know,
needling tibialis posterior on a 70 year old who's had um some sort of lumbar radiculopathy,
something that caused um you know,
sciatica.
Perhaps their,
their plantar flexors are like a rock and they have really terrible,
(07:20):
terrible blood circulation.
So I've had some success treating post chemotherapy foot numbness by,
by making sure I'm treating anything that I feel is going to be helpful for um cold or numbness in the feet.
And that's a,
(07:41):
a lot of the plantar flexors.
Um and don't forget soleus and gastro because the soleus is huge for um pumping blood,
pumping blood back up to the heart.
So the soleus needs to be able to help circulation as well.
So,
even though it doesn't go into the foot,
(08:04):
it is important for circulation.
So Soleus do not forget Soleus.
Um I try to help gastro too just for functional purposes.
Um But there's,
I've seen better success by thinking about the vascular aspects of post chemo foot numbness than just nerve entrapment.
(08:30):
Now,
when somebody's had uh some sort of,
you know,
radiculopathy like a sciatic um L five S one,
for instance,
um they,
they'll have the weakness often in the muscles as well as numbness.
So then I'm treating both um one really common.
(08:51):
One that is not that hard to help or to correct is the um sensory,
the peroneus,
um Peroneus,
uh cutaneous nerve,
the peroneal cutaneous nerve.
So the,
the,
you know how you have the deep peroneal nerve that helps a lot of the foot drop muscles.
(09:15):
Uh the superficial branch of the peroneal nerve is sensory.
Well,
it,
it's motor for the uh Peroneus longus and Brevis,
but it's sensory for the shin into the top of the foot.
So the dorsal foot and the front of the leg on the lateral part of the tibia is the peroneal cutaneous nerve distribution.
(09:44):
And you'll see that numbness on people who've had sciatica,
maybe they've had some sort of impact injury that affected the fibula.
Um Those people I find you can help really quickly.
Um sometimes you only need the motor point of the Peroneus longus and Brevis for like up to 10 minutes.
(10:10):
Some of the,
some people will have a,
be a good result just from that alone,
some people won't.
And in the case that the motor points were not sufficient,
you're likely going to be palpating near the head of the fibula for ropey bands in the Peroneus longus,
(10:30):
the upper Peroneus longus,
that seems to be the entrapment zone that I find and I will then dry needle.
But I have to,
you,
you know,
the nerve is there,
the there's like nerves there.
Um You don't wanna zing the nerve.
So you're gonna go crossfire superficially from like anterior to posterior so that you're not going deep enough to hit the nerve.
(10:55):
Um But you're gonna feel those fibers on the superficial level usually.
And if you can get a good couple twitches out of it,
it's usually enough release to un entrap that,
that superficial uh cutaneous nerve.
So,
um so that one,
I have fast good results on um it's the lateral uh plantar nerve that causes the numbness in the four toes,
(11:26):
four and five.
You'll see that a lot post sciatica.
So,
um so that one,
I wanted to share that I've had better success with those patients or I would say faster success.
I've had good success with those patients all along by treating the abductor Haasis and the uh tibialis posterior.
(11:51):
I rarely,
rarely will needle into the uh quadratus plant,
which is another entrapment zone for those nerves,
but very often it is an entrapment by the abductor Haasis.
And I had originally been needling the motor,
(12:14):
just the motor point that I learned from Doctor Perrotta's book.
Um You basically on the medial in the medial arch midway like one finger below the navicular bone is a really good motor point for the abductor Haasis.
Um I had very good success with a lot of people just using that.
(12:39):
But my success rate went up um noticeably when I started needling the abductor Haasis in the medial he uh heel area.
So sort of like inferior and posterior to the medial malleolus.
(13:02):
If you were to palpate the medial heel in line with the abductor hays,
you're probably just try to visualize how that muscle is gonna go back to the calcaneus um and become a tenant there.
So you gotta be like in the anterior third of the medial heel.
(13:24):
So you're always gonna be kneeling into the medial uh surface of that,
that heel probably right around where the skin color changes.
And you're going to be in that first anterior third of it.
You can often find a really good motor point there.
When you put stem on it,
you should see the muscle moving.
(13:44):
And I think that,
that uh you know,
basically,
I,
you know,
looking at images of the plantar nerves,
um you can see how it passes through the abductor hays in,
in that posterior area near the,
near the heel pato's um motor point is excellent and probably for electromyography,
(14:07):
it's,
it's all that's needed.
But there's this other one further back in the anterior heel medial area that I've been able to locate frequently that has given me faster success.
And it,
you know,
just,
just for like really logical reasons and going closer to where the nerve is gonna be entrapped by the muscle seems to have freed it,
(14:32):
freed it up faster for people.
So I wanted to share that because that's a recent switch up that I've made for the lateral plantar nerve numbness.
Um really treat,
like,
really think about ischemia for these patients,
like really think about blood flow.
(14:54):
Um And no,
I don't think that just a spinal segmental perfusion type treatment where you're going into like the lower thoracic and upper lumbar.
Um mfis muscles segment.
I,
I doubt that's an autonomic thing and it's not I really,
(15:18):
while some foot neuropathies are autonomic,
I don't think that most of them are,
I think it's mostly ischemia.
So you have to make your decision based on palpation if you're,
if you're palpating and those muscles don't feel ischemic and tight and you suspect there's an autonomic thing,
then go for it,
you know,
try your,
try your segmental approach.
(15:39):
Um Most of the patients that I see with foot numbness have ischemic muscles.
So I treat that way and I think the ischemia is what's leading to the just the rigidity of muscles causing the,
the nerves to get entrapped.
(16:01):
So I'm thinking about the nerves,
the nerve pathways as well as the blood circulation in the lower extremity.
So I would treat both ways.
And then I also recommend that my patients try to do something to inc to increase um vasodilation.
(16:23):
So,
um the doctor whose office I work in,
he gives people with foot um numbness a a supplement that increases ni nitric oxide.
And there are many out there.
And if you look in the fitness world,
like you go to a store that's more marketing toward um people who are into working out.
(16:47):
You'll s you'll see,
you know,
all the protein powders and things,
but no,
you'll see that a lot.
You'll see no boost or something.
It'll be nitric oxide boost or some sort of supplement that's meant to increase nitric oxide.
Those are a very good um addition for someone where you feel like their blood circulation needs to be improved,
(17:14):
to have more warmth in their feet,
more sensation.
So if they can do something on their side,
I also think that foot soaks are good.
Um you know,
like Epsom salts,
hot foot soaks or get one of those foot massagers,
you can get them,
I,
you know,
like a smarter image type thing.
You've seen those things like they'll even market them as like shiatsu or something but,
(17:38):
you know,
they've got these little mechanical things that spin around inside.
I think that could be really helpful,
um,
or getting foot massages,
but they really need to increase blood flow in their feet,
um,
to have faster results.
So I'm gonna try to un I'm gonna try to work on any kind of,
(17:59):
um,
sensory cutaneous nerve entrapments.
I'm going to work on any of the muscles that plantar flex.
Well,
I actually do end up working on like lots of the Dorsa flexors as well.
But you know,
when,
when the numbness is on the bottom,
I'm thinking first about plantar flexors.
Um,
I wanna increase blood circulation to all those muscles and I'm finding that I get really good results with a lot of people,
(18:26):
um,
guidance on what to tell people in the United States.
Um,
our seniors don't typically have any kind of insurance that will cover acupuncture that isn't low back pain.
And I don't want to go on that tangent.
But,
um,
our system in the United States,
(18:48):
you probably heard it's not very good.
So,
um,
so my patients who are senior citizens are paying out of pocket,
so they're using credit card.
So I don't tend to want to encourage them to keep trying beyond five sessions.
(19:10):
I'll tell them we really should start seeing improvements in five sessions.
And after that,
it will be up to you if you want to continue.
If you're not seeing results at that point,
I am not going to pressure you to keep trying because I,
you know,
(19:30):
I recognize it's a lot of money for people who are not,
who are on a fixed income and they're paying,
you know,
with a credit card or whatever.
Um Typically I'll see,
we'll see results in the first three,
mostly many times on the second visit.
After the second visit,
they'll start to feel something.
(19:50):
Now for your charting,
I personally use a percentage um rather than like a 1 to 10,
I use a percentage.
And I,
so when we start out before treatment,
I want to get a percentage from them of,
of how much sensation they have if it's 20% or 10 or 40 because we need to be able to track improvement.
(20:17):
And so I'm,
I'm putting my hand under their foot and on top of their foot and on each,
on each side I wanna get,
uh and I'm,
I'm stroking like just gently stroking and maybe putting some pressure because different things are gonna have,
you know,
input.
Um So I'm light touch and then some pressure and I wanna get their feedback on what percentage um of sensation they have.
(20:46):
So I get a baseline uh before treatment,
it might be 20%.
And that'll help us to both agree whether or not they're having improvement and then of course,
they'll have their random,
um you know,
objective sort of input about what they feel the most when a lot of times it's nighttime sensations,
(21:11):
um,
burning like that's on fire cold.
Um,
since,
uh,
sensation gets up regulated.
So to them just water,
hitting their foot in the shower could hurt.
Um,
there are different things that,
(21:32):
that people will,
will be focused on.
So those are important for our baseline because then I,
I wanna know if it's,
you feel like your feet feel ice cold at night,
then,
you know,
I want to know if that's getting better.
Um,
recently someone that I was treating whose feet feel ice cold at night,
(21:53):
they feel ice cold to me too.
So I'm definitely,
you know,
was,
was looking at that as a lot of ischemia and in fact,
after the third visit,
a lot of the warmth has returned to his feet.
I,
I think we're up to the fourth or fifth visit now.
Um So he's warm,
(22:14):
his feet are now warm up to the ball of his foot,
so his toes are cold,
but his whole foot is not cold and he said it's better at night,
it's getting better.
So I think,
you know,
in that case,
it,
you know,
it's a,
it's,
it's a,
it's vascular as well as uh nerve.
(22:34):
Um,
but I like to get those baseline things.
Um Just so we know if they are feeling improvement.
Um If you've been doing this for a while,
you know,
how patients only focus on the negative,
not everybody but many.
So as long as there's still some deficit,
they're gonna say it's not better.
(22:56):
You're gonna say,
is it better?
And they're gonna say no.
So the,
the only way you can agree if it is getting better is if you have some sort of baseline,
in which case they will start to say.
Oh,
yeah,
I guess I am.
I'm probably starting to feel about 50%.
So,
you know,
it's just you wanna get those baselines so that,
you know,
(23:16):
if you are,
if it is worth pursuing after five visits,
um,
it can take some time,
but as long as someone's not plateaued,
I'm suggesting that we keep moving,
keep,
keep treating,
that's what I'll tell them.
I'm,
I'm not pressuring you,
but if you're continuing to feel improvement,
you have not plateaued.
(23:37):
It's worth pursuing,
it's worth continuing.
And,
and like I said,
I'm,
I'm not into pressuring anybody,
but if they agree that it's helpful,
probably the first thing they found that was actually helping because we know medications don't help.
Um So anyway,
I,
(23:57):
um I'm trying to think if there's any other tips or tricks that I've found.
Um,
no,
I think that's it.
I think.
Really?
Oh,
well,
do not underestimate the ability of soft tissue manipulation,
like uh with a,
with a scraper tool,
like a metal Iastm tool,
(24:19):
gently working through any of those ischemic muscles.
I really think that helps getting those muscles able to pass over each other after they've been stuck for so long,
can really help.
Um That's one another thing that I think is helpful for,
for,
uh,
getting their blood circulation better.
(24:41):
Um You can do that on the bottom of the foot if they're not hyper sensitized.
Uh I find that that seems to be helpful.
So,
um,
those are my reflections on treating tough foot numbness and tingling and burning and cold.
Um,
(25:02):
another time we'll talk more about the motor deficit,
but I hope that was helpful to somebody,
especially that one in the medial heel.
Try that.
I'm really loving it.
So,
um OK,
that's it for this week and uh I will talk to you soon.
Welcome to the Acupuncture Outsider podcast.
My name is Richard Hazel and in the time it takes for you to commute to or from work,
I hope to have shared something of interest about orthopedic acupuncture using motor points,
trigger points,
(00:23):
myofascial slings,
uh neuro functional acupuncture segmental treatments.
Anything that crosses my mind that seems to be of interest.
I hope you'll enjoy it.
Hello and welcome to another episode of The Acupuncture Outsider.
(00:45):
This is Richard Hazel and today I want to talk about some foot neuropathy successes and see if uh see if I can give you some tips that have helped me with some patients.
Um off the bat.
I just wanna say that I am not an expert in treating foot neuropathy,
(01:08):
but when someone has it,
I make an attempt to help them and I've learned some things over um the years of trying to um help those people and I'm specifically thinking about um numbness,
tingling,
(01:29):
cold or burning sensations,
not um I uh maybe another time we'll talk about other things like foot drop and things like that.
I've done some,
I did something about foot drop before and um but I don't wanna talk about the,
the motor nerve,
I wanna talk about sensory nerves.
(01:50):
Um So I've had recently had some successes that came about because of me,
you know,
experimenting a little bit.
Um neuropathy,
foot neuropathy,
um foot numbness is,
or tingling or,
(02:11):
or cold or burning,
they tend to,
people tend to have all of those symptoms at different times.
Um It's as complicated as treating migraines because there are just so many ways to get foot neuropathy.
Uh So you can't,
you can't say I always do this and I or I never do this.
(02:32):
Um You kind of have to know the patient's history and make some um educated guesses about how to best start treating those patients.
And they may have numbness only on the bottom of the feet or they may have numbness on only part of the bottom of their foot or they may have cold um feet,
(02:59):
they may have numbness on the top of the foot.
So,
e everybody's different and that's what makes it hard is because I can't say always do this.
Um What I've learned though,
which I'm wanted to share is regardless of what I'm gonna tell you like what points I use or whatever because there's no set um protocol that I'm aware of,
(03:28):
which is why I've had to sort of study it on my own and try to figure out the best way to treat.
Um I would say always remember that the numbness can be a combination of nerve entrapment and vascular issues.
(03:51):
So,
and I really think do not underestimate the ability of ischemia to cause numbness and the ability of ischemic muscles to entrap nerves.
So,
um,
I,
(04:11):
after a P period of time,
I really had,
had some poor luck,
um,
really bad luck trying to help people with foot numbness or foot burning after chemotherapy.
And I'll just say like,
don't,
you know,
I don't,
I don't treat anybody who's being treated for cancer for because they need to be able to heal for me to help them.
(04:37):
So this is like once they're in remission and they have foot numbness,
I've tried to help people um and have had a lot of failure with it and I recently started to see see better results by treating it as ischemia more than nerve entrapment.
(05:04):
Um If you,
if you're familiar with the Plantar Nerve um podcast where I talk about how the tibial nerve splits and becomes the,
there is a plantar nerve that goes into three branches at the bottom of the foot is sensory nerve.
The plantar nerve is motor and sensory,
but the sensory part is obviously the one that I'm concerned about for numbness.
(05:28):
So there's um there are different branches.
So you're always wanting to consider like what um which branch or branches are,
are most affected.
There's a heel,
there's a medial foot and then there's like a lateral plantar nerve that um affects the bottom of the outer part of the foot and usually toes four and five,
(05:51):
especially five.
So you kind of wanna get a sense of that.
And um I have noticed that when people have numbness on the bottom of their foot,
they very often do have extremely tight plantar flexors like the tibialis posterior,
(06:14):
which can cause that tarsal tunnel issue.
They'll have ischemic toe flexors,
they'll have ischemic ad uh actor um Abductor Hays,
like where that other,
where one of those branches can get entrapped,
they'll have really tight um dorsiflexors like their tib anterior extensor,
(06:37):
digitorum longus,
their perons are tight.
Um People in their sixties and seventies have just ischemic ischemic low leg muscles.
Um And,
you know,
the ones that I'm treating for neuropathy,
it's,
it's extreme.
(06:57):
So,
and I probably talked about that like,
you know,
needling tibialis posterior on a 70 year old who's had um some sort of lumbar radiculopathy,
something that caused um you know,
sciatica.
Perhaps their,
their plantar flexors are like a rock and they have really terrible,
(07:20):
terrible blood circulation.
So I've had some success treating post chemotherapy foot numbness by,
by making sure I'm treating anything that I feel is going to be helpful for um cold or numbness in the feet.
And that's a,
(07:41):
a lot of the plantar flexors.
Um and don't forget soleus and gastro because the soleus is huge for um pumping blood,
pumping blood back up to the heart.
So the soleus needs to be able to help circulation as well.
So,
even though it doesn't go into the foot,
(08:04):
it is important for circulation.
So Soleus do not forget Soleus.
Um I try to help gastro too just for functional purposes.
Um But there's,
I've seen better success by thinking about the vascular aspects of post chemo foot numbness than just nerve entrapment.
(08:30):
Now,
when somebody's had uh some sort of,
you know,
radiculopathy like a sciatic um L five S one,
for instance,
um they,
they'll have the weakness often in the muscles as well as numbness.
So then I'm treating both um one really common.
(08:51):
One that is not that hard to help or to correct is the um sensory,
the peroneus,
um Peroneus,
uh cutaneous nerve,
the peroneal cutaneous nerve.
So the,
the,
you know how you have the deep peroneal nerve that helps a lot of the foot drop muscles.
(09:15):
Uh the superficial branch of the peroneal nerve is sensory.
Well,
it,
it's motor for the uh Peroneus longus and Brevis,
but it's sensory for the shin into the top of the foot.
So the dorsal foot and the front of the leg on the lateral part of the tibia is the peroneal cutaneous nerve distribution.
(09:44):
And you'll see that numbness on people who've had sciatica,
maybe they've had some sort of impact injury that affected the fibula.
Um Those people I find you can help really quickly.
Um sometimes you only need the motor point of the Peroneus longus and Brevis for like up to 10 minutes.
(10:10):
Some of the,
some people will have a,
be a good result just from that alone,
some people won't.
And in the case that the motor points were not sufficient,
you're likely going to be palpating near the head of the fibula for ropey bands in the Peroneus longus,
(10:30):
the upper Peroneus longus,
that seems to be the entrapment zone that I find and I will then dry needle.
But I have to,
you,
you know,
the nerve is there,
the there's like nerves there.
Um You don't wanna zing the nerve.
So you're gonna go crossfire superficially from like anterior to posterior so that you're not going deep enough to hit the nerve.
(10:55):
Um But you're gonna feel those fibers on the superficial level usually.
And if you can get a good couple twitches out of it,
it's usually enough release to un entrap that,
that superficial uh cutaneous nerve.
So,
um so that one,
I have fast good results on um it's the lateral uh plantar nerve that causes the numbness in the four toes,
(11:26):
four and five.
You'll see that a lot post sciatica.
So,
um so that one,
I wanted to share that I've had better success with those patients or I would say faster success.
I've had good success with those patients all along by treating the abductor Haasis and the uh tibialis posterior.
(11:51):
I rarely,
rarely will needle into the uh quadratus plant,
which is another entrapment zone for those nerves,
but very often it is an entrapment by the abductor Haasis.
And I had originally been needling the motor,
(12:14):
just the motor point that I learned from Doctor Perrotta's book.
Um You basically on the medial in the medial arch midway like one finger below the navicular bone is a really good motor point for the abductor Haasis.
Um I had very good success with a lot of people just using that.
(12:39):
But my success rate went up um noticeably when I started needling the abductor Haasis in the medial he uh heel area.
So sort of like inferior and posterior to the medial malleolus.
(13:02):
If you were to palpate the medial heel in line with the abductor hays,
you're probably just try to visualize how that muscle is gonna go back to the calcaneus um and become a tenant there.
So you gotta be like in the anterior third of the medial heel.
(13:24):
So you're always gonna be kneeling into the medial uh surface of that,
that heel probably right around where the skin color changes.
And you're going to be in that first anterior third of it.
You can often find a really good motor point there.
When you put stem on it,
you should see the muscle moving.
(13:44):
And I think that,
that uh you know,
basically,
I,
you know,
looking at images of the plantar nerves,
um you can see how it passes through the abductor hays in,
in that posterior area near the,
near the heel pato's um motor point is excellent and probably for electromyography,
(14:07):
it's,
it's all that's needed.
But there's this other one further back in the anterior heel medial area that I've been able to locate frequently that has given me faster success.
And it,
you know,
just,
just for like really logical reasons and going closer to where the nerve is gonna be entrapped by the muscle seems to have freed it,
(14:32):
freed it up faster for people.
So I wanted to share that because that's a recent switch up that I've made for the lateral plantar nerve numbness.
Um really treat,
like,
really think about ischemia for these patients,
like really think about blood flow.
(14:54):
Um And no,
I don't think that just a spinal segmental perfusion type treatment where you're going into like the lower thoracic and upper lumbar.
Um mfis muscles segment.
I,
I doubt that's an autonomic thing and it's not I really,
(15:18):
while some foot neuropathies are autonomic,
I don't think that most of them are,
I think it's mostly ischemia.
So you have to make your decision based on palpation if you're,
if you're palpating and those muscles don't feel ischemic and tight and you suspect there's an autonomic thing,
then go for it,
you know,
try your,
try your segmental approach.
(15:39):
Um Most of the patients that I see with foot numbness have ischemic muscles.
So I treat that way and I think the ischemia is what's leading to the just the rigidity of muscles causing the,
the nerves to get entrapped.
(16:01):
So I'm thinking about the nerves,
the nerve pathways as well as the blood circulation in the lower extremity.
So I would treat both ways.
And then I also recommend that my patients try to do something to inc to increase um vasodilation.
(16:23):
So,
um the doctor whose office I work in,
he gives people with foot um numbness a a supplement that increases ni nitric oxide.
And there are many out there.
And if you look in the fitness world,
like you go to a store that's more marketing toward um people who are into working out.
(16:47):
You'll s you'll see,
you know,
all the protein powders and things,
but no,
you'll see that a lot.
You'll see no boost or something.
It'll be nitric oxide boost or some sort of supplement that's meant to increase nitric oxide.
Those are a very good um addition for someone where you feel like their blood circulation needs to be improved,
(17:14):
to have more warmth in their feet,
more sensation.
So if they can do something on their side,
I also think that foot soaks are good.
Um you know,
like Epsom salts,
hot foot soaks or get one of those foot massagers,
you can get them,
I,
you know,
like a smarter image type thing.
You've seen those things like they'll even market them as like shiatsu or something but,
(17:38):
you know,
they've got these little mechanical things that spin around inside.
I think that could be really helpful,
um,
or getting foot massages,
but they really need to increase blood flow in their feet,
um,
to have faster results.
So I'm gonna try to un I'm gonna try to work on any kind of,
(17:59):
um,
sensory cutaneous nerve entrapments.
I'm going to work on any of the muscles that plantar flex.
Well,
I actually do end up working on like lots of the Dorsa flexors as well.
But you know,
when,
when the numbness is on the bottom,
I'm thinking first about plantar flexors.
Um,
I wanna increase blood circulation to all those muscles and I'm finding that I get really good results with a lot of people,
(18:26):
um,
guidance on what to tell people in the United States.
Um,
our seniors don't typically have any kind of insurance that will cover acupuncture that isn't low back pain.
And I don't want to go on that tangent.
But,
um,
our system in the United States,
(18:48):
you probably heard it's not very good.
So,
um,
so my patients who are senior citizens are paying out of pocket,
so they're using credit card.
So I don't tend to want to encourage them to keep trying beyond five sessions.
(19:10):
I'll tell them we really should start seeing improvements in five sessions.
And after that,
it will be up to you if you want to continue.
If you're not seeing results at that point,
I am not going to pressure you to keep trying because I,
you know,
(19:30):
I recognize it's a lot of money for people who are not,
who are on a fixed income and they're paying,
you know,
with a credit card or whatever.
Um Typically I'll see,
we'll see results in the first three,
mostly many times on the second visit.
After the second visit,
they'll start to feel something.
(19:50):
Now for your charting,
I personally use a percentage um rather than like a 1 to 10,
I use a percentage.
And I,
so when we start out before treatment,
I want to get a percentage from them of,
of how much sensation they have if it's 20% or 10 or 40 because we need to be able to track improvement.
(20:17):
And so I'm,
I'm putting my hand under their foot and on top of their foot and on each,
on each side I wanna get,
uh and I'm,
I'm stroking like just gently stroking and maybe putting some pressure because different things are gonna have,
you know,
input.
Um So I'm light touch and then some pressure and I wanna get their feedback on what percentage um of sensation they have.
(20:46):
So I get a baseline uh before treatment,
it might be 20%.
And that'll help us to both agree whether or not they're having improvement and then of course,
they'll have their random,
um you know,
objective sort of input about what they feel the most when a lot of times it's nighttime sensations,
(21:11):
um,
burning like that's on fire cold.
Um,
since,
uh,
sensation gets up regulated.
So to them just water,
hitting their foot in the shower could hurt.
Um,
there are different things that,
(21:32):
that people will,
will be focused on.
So those are important for our baseline because then I,
I wanna know if it's,
you feel like your feet feel ice cold at night,
then,
you know,
I want to know if that's getting better.
Um,
recently someone that I was treating whose feet feel ice cold at night,
(21:53):
they feel ice cold to me too.
So I'm definitely,
you know,
was,
was looking at that as a lot of ischemia and in fact,
after the third visit,
a lot of the warmth has returned to his feet.
I,
I think we're up to the fourth or fifth visit now.
Um So he's warm,
(22:14):
his feet are now warm up to the ball of his foot,
so his toes are cold,
but his whole foot is not cold and he said it's better at night,
it's getting better.
So I think,
you know,
in that case,
it,
you know,
it's a,
it's,
it's a,
it's vascular as well as uh nerve.
(22:34):
Um,
but I like to get those baseline things.
Um Just so we know if they are feeling improvement.
Um If you've been doing this for a while,
you know,
how patients only focus on the negative,
not everybody but many.
So as long as there's still some deficit,
they're gonna say it's not better.
(22:56):
You're gonna say,
is it better?
And they're gonna say no.
So the,
the only way you can agree if it is getting better is if you have some sort of baseline,
in which case they will start to say.
Oh,
yeah,
I guess I am.
I'm probably starting to feel about 50%.
So,
you know,
it's just you wanna get those baselines so that,
you know,
(23:16):
if you are,
if it is worth pursuing after five visits,
um,
it can take some time,
but as long as someone's not plateaued,
I'm suggesting that we keep moving,
keep,
keep treating,
that's what I'll tell them.
I'm,
I'm not pressuring you,
but if you're continuing to feel improvement,
you have not plateaued.
(23:37):
It's worth pursuing,
it's worth continuing.
And,
and like I said,
I'm,
I'm not into pressuring anybody,
but if they agree that it's helpful,
probably the first thing they found that was actually helping because we know medications don't help.
Um So anyway,
I,
(23:57):
um I'm trying to think if there's any other tips or tricks that I've found.
Um,
no,
I think that's it.
I think.
Really?
Oh,
well,
do not underestimate the ability of soft tissue manipulation,
like uh with a,
with a scraper tool,
like a metal Iastm tool,
(24:19):
gently working through any of those ischemic muscles.
I really think that helps getting those muscles able to pass over each other after they've been stuck for so long,
can really help.
Um That's one another thing that I think is helpful for,
for,
uh,
getting their blood circulation better.
(24:41):
Um You can do that on the bottom of the foot if they're not hyper sensitized.
Uh I find that that seems to be helpful.
So,
um,
those are my reflections on treating tough foot numbness and tingling and burning and cold.
Um,
(25:02):
another time we'll talk more about the motor deficit,
but I hope that was helpful to somebody,
especially that one in the medial heel.
Try that.
I'm really loving it.
So,
um OK,
that's it for this week and uh I will talk to you soon.
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