title: Mountaineering-induced bilateral plantar paresthesia.
abstract: BACKGROUND
  Flat feet (pes planus) have been implicated in multiple musculoskeletal complaints, which are often exacerbated by lack of appropriate arch support or intense exercise.
  
  
  OBJECTIVE
  To investigate the efficacy of osteopathic manipulative treatment (OMT) on a patient (K.K.H.) with mountaineering-induced bilateral plantar paresthesia and to assess the association of pes planus with paresthesia in members of the mountaineering expedition party that accompanied the patient.
  
  
  METHODS
  A patient history and physical examination of the musculoskeletal system were performed. The hindfoot, midfoot, forefoot, big toe, and distal toes were evaluated for neurologic function, specifically pin, vibration, 10-g weight sensitivity, and 2-point discrimination during the 4-month treatment period. To determine if OMT could augment recovery, the patient volunteered to use the contralateral leg as a control, with no OMT performed on the sacrum or lower back. To determine if pes planus was associated with mountaineering-induced paresthesia, a sit-to-stand navicular drop test was performed on members of the expedition party.
  
  
  RESULTS
  Osteopathic manipulative treatment improved fibular head motion and muscular flexibility and released fascial restrictions of the soleus, hamstring, popliteus, and gastrocnemius. The patient's perception of stiffness, pain, and overall well-being improved with OMT. However, OMT did not shorten the duration of paresthesia. Of the 9 expedition members, 2 experienced paresthesia. Average navicular drop on standing was 5.1 mm for participants with no paresthesia vs 8.9 mm for participants with paresthesia (t test, P<.01; Mann-Whitney rank sum test, P=.06).
  
  
  CONCLUSIONS
  These preliminary findings suggest that weakened arches may contribute to mountaineering-induced plantar paresthesia. Early diagnosis of pes planus and treatment with orthotics (which may prevent neuropathies)--or, less ideally, OMT after extreme exercise--should be sought to relieve tension and discomfort.
authors.affiliation: From the departments of physiology (Dr Henderson) and osteopathic manipulative medicine (Dr Heinking) at the Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Illinois, and from Advocate Illinois Masonic Medical Center in Downers Grove, Illinois (Dr Parker). At the time of submission, Dr Parker was an osteopathic medical student at the Midwestern University/Chicago College of Osteopathic Medicine khende@midwestern.edu.
authors.forename: Kyle K
authors.initials: KK
authors.lastname: Henderson
authors.affiliation: From the departments of physiology (Dr Henderson) and osteopathic manipulative medicine (Dr Heinking) at the Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Illinois, and from Advocate Illinois Masonic Medical Center in Downers Grove, Illinois (Dr Parker). At the time of submission, Dr Parker was an osteopathic medical student at the Midwestern University/Chicago College of Osteopathic Medicine.
authors.forename: Justine
authors.initials: J
authors.lastname: Parker
authors.affiliation: From the departments of physiology (Dr Henderson) and osteopathic manipulative medicine (Dr Heinking) at the Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Illinois, and from Advocate Illinois Masonic Medical Center in Downers Grove, Illinois (Dr Parker). At the time of submission, Dr Parker was an osteopathic medical student at the Midwestern University/Chicago College of Osteopathic Medicine.
authors.forename: Kurt P
authors.initials: KP
authors.lastname: Heinking
mesh_terms: D000328:Adult; D005528:Foot / Q000294:innervation*; D005534:Foot Diseases / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D026301:Manipulation, Osteopathic / Q000379:methods*; D009051:Mountaineering; D010292:Paresthesia / Q000209:etiology* / Q000628:therapy