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Case study: Chronic Knee Pain and Toe Numbness

Patient has chronic pain in both knee and had undergone knee meniscus surgery back in 2018. The pain came back in 2022 and in Dec 2022 patient took another knee MRI which revealed that there is tear in the left knee meniscus. When walking there is constant pain in both knees, with the left knee pain more pronounced. Besides the knee pain, there is also pain and constant numbness in the 4th toe joint of both foot, again with the left side pain being more evident. The pain in the toe is such that the patient cannot walk for long distance without stopping. Examination of the foot revealed that the nerve is compressed in the foot and the orthopedic specialist recommends surgery.

This case is complex as it involves multiple systems. The plantar fascia of both foot is very tight with a number of muscles being pulled in various directions. The mobility of the tibia and fibula is very low and both calf and hamstring muscles are tight. Besides the structural problem of the lower limb, there is also very strong abdominal pressure, causing the muscle on the inner side of both thigh to be pulled very strongly, the left side being tighter.

In order to allow the knee pain to improve, the mobility in the foot arch and SI joint needs to be improved and the space in the fascia gradually restored as muscles are able to move and release. As for the foot 4th toe pain, the numbness and pain is due to the toe being pulled by a number of muscle on the foot plantar, these muscles need to be released. The difficulty in this case is in the release of the muscles as they are very tight and not easy to adjust.

After 6-7 sessions of treatment, the pain on both knee reduced significantly, and the 4th toe of each foot also improved a lot, the patient can now walk for long distances without significant pain/numbness coming from the toes. This case demonstrates that if fascia structure is not restored, even after going for knee meniscus surgery, the meniscus can be teared again, this is because there is a lot of tension in the lower limb system, causing the meniscus to have more friction.

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