Trigger Pointsper Rue Tikker

Into the interspace between each toe (from top down)

Inject to the level of the bone behind

sustentaculum tali

Just above and below the lateral maleoli

Lateral to the dorsalis pedis artery

Inject laterally at cuboid, one deep (needle

completely buried), one shallow

To tape, first wrap in rolled gauze - not too tight, then wrap from medial to lateral with stretch wrap. Do not wrap tightly. Secure with

tape. (zonas - flesh colored tape, easy to tear - 2” and

1” tape) Replace at each visit.

The idea is to stabilize the bones (cuboid) so that they may heal while stabilizing

the arch.

Taping

• on a chronic treatment, the tape is pulled from the bottom toward the top equally to keep the foot in neutral.

Codes for the foot

• Codes 98925 E&M

• Codes 97140

• Codes 29540

• Ask every new patient if they have foot problems.

• 1 out of 4 do.

What you can treat• Ankle injuries

• Plantar fasciitis

• pseudoneuroma pain

• tired aching feet

• metatarsalgia

• swelling (unilateral)

Frequency of Treatment• each day for one week

• every other day for one week

• twice the third week

• twice for follow up

• every other problem is twice per week for 12-14 treatments

Plantar Fasciitis

• therapeutic U/S works best for plantar fasciitis and metatarsalgia.

Gout

• From Rue’s dad - internal med doc who practiced until 90.

• Gout is caused by red meat, chicken, turkey and shellfish and beer. Take them off of these and the gout will clear up.