title: Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases.
abstract: OBJECTIVE
  The purpose of this retrospective case series is to describe treatment outcomes for patients with plantar digital neuralgia (PDN) (Morton's neuroma) who were treated using foot manipulation.
  
  
  METHODS
  Charts were reviewed retrospectively for patients with a diagnosis of PDN and who received a minimum of 6 treatments consisting of manipulation alone. Visual analogue pain scales (VAS) and pressure threshold meter readings (PTM) were extracted as outcome measures.
  
  
  RESULTS
  Thirty-eight cases met inclusion criteria. Mean pretreatment duration of pain was 28 months. Mean pretreatment VAS was 69.5/100 mm. Mean pretreatment PTM was 2.54 Kp. By the sixth treatment, 30 (79%) of the 38 patients scored a VAS of 0 mm and a further 4 (10%) were below 10 mm. Contralateral limb PTM showed a mean pre-treatment score of 5.5 Kp, which rose slightly to 5.85 Kp. This compared to a pre-treatment score of 2.54 Kp rising to 5.86 Kp in the affected limb. This represents a 126% increase in the affected side compared to 6.5% in the unaffected limb. Statistical analysis demonstrated a significant linear trend between decreasing VAS and manipulation (P < .001).
  
  
  CONCLUSIONS
  The patients with PDN who were included in this case series improved with conservative care that included only foot manipulation.
authors.affiliation: PhD Student, Department of Life Sciences, Queen Margaret University, Edinburgh, Scotland.
authors.forename: David G
authors.initials: DG
authors.lastname: Cashley
authors.affiliation: Doctor, Division of Population Health Sciences, Medical Research Institute, University of Dundee, Dundee, Scotland.
authors.forename: Lynda
authors.initials: L
authors.lastname: Cochrane
keywords: Foot; Musculoskeletal manipulations; Neuroma